PATHOPHYSIOLOGY AND INDICATIONS FOR MEDIALIZATION THYROPLASTY IN PATIENTS WITH DYSPHAGIA AND ASPIRATION

Medialization thyroplasty is generally considered a phonosurgical proc edure for voice augmentation in patients with glottic insufficiency. T his article addresses specifically the issue of dysphagia and aspirati on in patients with laryngeal paralysis, A retrospective review of pat ients undergoing medialization thyroplasty is performed, From 1991 to 1995, 84 patients at The Johns Hopkins Medical Institutions underwent medialization thyroplasty for unilateral vocal fold motion impairment, At presentation 48 patients had isolated recurrent laryngeal nerve in jury, 26 with combined superior laryngeal nerve/recurrent laryngeal ne rve injury and In with idiopathic nerve injury, Sixty-one percent of p atients had swallowing difficulties. The severity of symptoms is great er in the superior laryngeal nerve/recurrent laryngeal nerve group. Be fore surgery 13 patients were dependent on feeding tubes. Nine patient s improved to the point at which all alimentation was taken by mouth a nd tube feedings were discontinued after medialization thyroplasty, On e patient was subsequently converted to a full oral diet after cricoph aryngeal myotomy. Three patients remained dependent on feeding tubes, The pathophysiology of dysphagia including clinical and experimental o bservations is reviewed, In addition, the nonsurgical and surgical app roaches to treatment of patients with laryngeal paralysis are reviewed .