Thyroplasty

Overview

What is thyroplasty (medialization laryngoplasty)?

Medialization laryngoplasty (formerly known as thyroplasty) is a surgical treatment for vocal cord paralysis. Your surgeon places an implant into your paralyzed or weak vocal cord. The implant moves a nonfunctioning vocal cord toward the functioning one to allow for better voicing.

What is vocal cord paralysis?

Vocal cord paralysis affects your voice box (larynx) in your throat. Your voice box has two vocal cords (also called vocal folds). These smooth muscles help you breathe, speak and swallow. When you talk or cough, air moves through your lungs and into your windpipe (trachea) and across your voice box. Your vocal cords vibrate as air passes through them. This is what produces the sound that’s shaped into your voice.

When you have unilateral vocal cord paralysis, one vocal cord doesn’t move (paralysis). Sometimes, the movement is very weak. It’s uncommon for vocal cord paralysis to affect both vocal cords. Bilateral vocal cord paralysis can be a life-threatening/altering condition that requires specialized care by an ear nose and throat (ENT) surgeon.

What are the signs of unilateral vocal cord paralysis?

Symptoms of vocal cord paralysis include:

Who needs thyroplasty (medialization laryngoplasty)?

Some people have mild voice impairment with vocal cord paralysis. These people may be meeting their vocal needs without surgical intervention. Your surgeon may recommend surgery when symptoms are severe, life-disrupting or potentially life-threatening. Overall, if you’re struggling to meet the vocal demands of your work and life, medicalization laryngoplasty can be very helpful in restoring vocal function.

Certain illnesses and medical procedures may lead to the need for thyroplasty. These include:

Procedure Details

Who performs thyroplasty (medialization laryngoplasty)?

A laryngeal surgeon performs this procedure. This medical doctor specializes in diagnosing and treating conditions that affect your larynx. Laryngology is an ear, nose and throat (ENT or otolaryngology) subspecialty.

What happens before thyroplasty (medialization laryngoplasty)?

You should follow your healthcare provider’s instructions on steps to take before the procedure. For instance, you may need to:

What happens during thyroplasty (medialization laryngoplasty)?

Thyroplasty is a surgical procedure that takes place in an operating room.

During thyroplasty to treat unilateral vocal cord paralysis, your surgeon:

  • Makes a small incision in your neck and locates your voice box.
  • Creates a small window in your voice box alongside your vocal cord.
  • Tests your voice and places a customized implant that improves your voice.
  • Closes the incision with dissolvable stitches.
  • Secures a bandage to your neck.

Risks / Benefits

How effective is thyroplasty (medialization laryngoplasty)?

Thyroplasty can help restore your voice and treat other symptoms of vocal cord paralysis. People often experience a significant improvement in their vocal function.

What are the risks of thyroplasty (medialization laryngoplasty)?

Any surgery carries a risk of infection and bleeding. You’ll have a small scar on your neck from the incision.

Some of the symptoms that existed before surgery may still be present for a short while after surgery as your voice box heals. You may have temporary neck soreness, hoarseness, vocal changes, and breathing and swallowing difficulties. Only in rare instances are these side effects permanent.

Recovery and Outlook

How long does it take to recover from thyroplasty (medialization laryngoplasty)?

You’ll be discharged the same day or stay overnight in the hospital. You’ll need to rest your voice for a few days, but complete silence isn’t necessary.

When you resume talking, don’t overdo it. This means no yelling, loud talking or long conversations. After one week, you can resume all normal communication.

To aid recovery:

  • Drink plenty of fluids and start with soft foods if you have a sore throat.
  • Don’t shower, and keep the bandaged area of your neck dry, for three days after surgery.
  • Take antibiotics, steroids and pain relievers as prescribed by your healthcare provider.
  • Avoid lifting anything that weighs more than 15 pounds or engaging in strenuous activity like running for two weeks. Walking is OK.
  • Participate in voice therapy if recommended by your healthcare provider.

Is a thyroplasty permanent?

In rare instances, your healthcare provider may need to remove or revise your implant. But the device is often permanent.

When to Call the Doctor

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

  • Difficulty breathing.
  • Extreme pain.
  • Signs of infection, such as fever or yellow discharge.
  • Swelling (edema) or bleeding at the incision site.

A note from Cleveland Clinic

Medialization laryngoplasty (formerly known as thyroplasty) can help restore your voice and improve your ability to swallow when you have unilateral vocal cord paralysis or spasmodic dysphonia. If nonsurgical treatments don’t help, you should ask your healthcare provider about this treatment.

Last reviewed by a Cleveland Clinic medical professional on 04/13/2022.

References

  • Blackshaw H, Carding P, Jepson M, et al. Does laryngeal reinnervation or type 1 thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial. (https://pubmed.ncbi.nlm.nih.gov/28965097/) BMJ Open. 2017 Sep;7(9):e016871. Accessed 4/13/2022.
  • Crawley BK, Sulica L. Vocal Fold Paralysis as a Delayed Consequence of Neck and Chest Radiotherapy. (https://pubmed.ncbi.nlm.nih.gov/25931294/) Otolaryngol Head Neck Surg. 2015 Aug;153(2):239-43. Accessed 4/13/2022.
  • Ho GY, Leonhard M, Denk-Linnert DM, Schneider-Stickler B. Pre- and intraoperative acoustic and functional assessment of the novel APrevent® VOIS implant during routine medialization thyroplasty. (https://pubmed.ncbi.nlm.nih.gov/31845039/) Eur Arch Otorhinolaryngol. 2020 Mar;277(3):809-817. Accessed 4/13/2022.
  • Junlapan A, Sung CK, Damrose EJ. Type 1 thyroplasty: A safe outpatient procedure. (https://pubmed.ncbi.nlm.nih.gov/30582623/) Laryngoscope. 2019 Jul;129(7):1640-1646. Accessed 4/13/2022.
  • Prasad VMN, Remacle M. Medialization Thyroplasty and Arytenoid Adduction for Management of Neurological Vocal Fold Immobility. (https://pubmed.ncbi.nlm.nih.gov/33166967/) Adv Otorhinolaryngol. 2020 Nov;85:85-97. Accessed 4/13/2022.
  • Ryu IS, Nam SY, Han MW, et al. Long-Term Voice Outcomes After Thyroplasty for Unilateral Vocal Fold Paralysis. (https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/1151735) Arch Otolaryngol Head Neck Surg. 2012 Apr;138(4):347-351. Accessed 4/13/2022.

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