MIGRATION OF THE ANTERIOR SEGMENT FOLLOWING ANTERIOR COMMISSURE ADVANCEMENT - A CASE-REPORT

A 53-year-old man with severe vocal fold atrophy underwent bilateral t ype 1 thyroplasty and anterior commissure advancement. Postoperatively , he developed a strained voice with less projection and volume than p rior to surgery. This was verified by objective assessment of vocal fu nction. Videoendoscopy revealed bilateral false vocal fold fullness an d blunting of the anterior commissure. Magnetic resonance imaging demo nstrated cephalic migration of the posterior ends of the implants and retrusion of the anterior commissure segment. Surgical exploration rev ealed that the type 1 implants had rotated and buckled. The anterior c ommissure segment was rotated and displaced inferiorly, and its inferi or surface was tethered to the cricoid by scar tissue. The implants we re removed, the anterior segment was repositioned and rigidly fixed, a nd bilateral lipoinjection performed. Vocal function was significantly improved, and endoscopy revealed normal tension and length of the voc al folds and restoration of the anterior commissure. This case demonst rates the importance of stable fixation during laryngeal framework sur gery.