What Is Medialization Laryngoplasty? A Procedure Explained

Medialization laryngoplasty is a surgical procedure designed to improve voice quality and address difficulties with swallowing caused by a vocal fold that does not move properly. The primary goal of this intervention is to reposition a paralyzed, atrophied, or scarred vocal fold closer to the midline of the throat. This repositioning allows the affected vocal fold to make better contact with the healthy one, which is necessary for clear voice production and safe swallowing. By restoring proper glottal closure, the procedure aims to reduce symptoms like breathiness and vocal weakness, enhancing vocal function.

What is Vocal Fold Paralysis?

Vocal fold paralysis occurs when the nerve impulses to the vocal folds, located within the voice box (larynx), are disrupted, causing one or both vocal folds to lose their ability to move. The vocal folds are flexible bands of muscle tissue that vibrate together to produce sound and also protect the airway during swallowing. When one vocal fold is paralyzed, a gap can form, preventing complete closure.

This condition can arise from various causes, including nerve damage due to head and neck injuries, tumors, certain diseases, or complications from surgeries involving the neck or chest, such as thyroid or carotid artery procedures. In some cases, the cause remains unknown, referred to as idiopathic paralysis, which accounts for up to 50% of cases. Viral infections, such as the common cold virus, can cause nerve inflammation leading to this paralysis.

Symptoms of vocal fold paralysis include a breathy or hoarse voice, reduced vocal pitch or loudness, and the need to take frequent breaths while speaking. Individuals may also experience difficulties swallowing, such as choking or coughing when food or liquids enter the windpipe (aspiration), and an ineffective cough. These issues arise because the paralyzed vocal fold cannot close properly to protect the airway.

How Medialization Laryngoplasty Works

Medialization laryngoplasty, also known as Type I thyroplasty, is a surgical technique that aims to move the immobile vocal fold closer to the functional one, thereby improving glottal closure during speech and swallowing. This procedure is performed to provide support to a vocal fold that lacks its normal bulk or mobility.

The surgeon makes a small incision, approximately one inch long, in the neck, often placed in or parallel to a skin crease to minimize visible scarring. Through this incision, the layers of muscle are moved aside to expose the thyroid cartilage, which forms the front part of the voice box. A small window is then created in the thyroid cartilage, directly beneath the paralyzed vocal fold.

An implant material is then inserted through this window into the paraglottic space, pushing the affected vocal fold towards the midline. Commonly used implant materials include silicone, Gore-Tex, or cartilage grafts. The procedure can be performed under local anesthesia with sedation, allowing the patient to speak during the process to help the surgeon optimize voice quality, though general anesthesia is also an option. The implant is secured to prevent migration, ensuring a relatively permanent solution.

Life After Surgery and Voice Therapy

Following medialization laryngoplasty, patients can expect an immediate period of recovery, which involves a short hospital stay, often outpatient. Initial voice changes are common, with the voice possibly sounding hoarse or rough in a different way than before surgery for several weeks to months. Pain can be managed with over-the-counter pain relievers like acetaminophen, though stronger medication may be prescribed if needed.

Patients should rest their voice for a few days, avoiding yelling or strenuous vocal use, but complete silence is not required. Physical activity restrictions include avoiding heavy lifting (over 15 pounds) or strenuous exercise for about two weeks; light exercise and walking are permissible. Incision care involves keeping the site dry for several days, with instructions for showering and applying moisturizer or antibiotic ointment after initial healing.

Post-operative voice therapy is recommended to optimize the surgical outcome. A speech-language pathologist helps patients adapt to the newly positioned vocal fold, improving voice clarity, reducing vocal effort, and enhancing swallowing function. While immediate voice improvement may be noticed, the final results become apparent after about six weeks as swelling subsides and the vocal folds adjust to their new position.

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