SILASTIC MEDIALIZATION AND ARYTENOID ADDUCTION - THE VANDERBILT EXPERIENCE - A REVIEW OF 116 PHONOSURGICAL PROCEDURES

From April 1987 to April 1992, 116 phonosurgical procedures were perfo rmed to treat glottal incompetence. The initial numbers of these surgi cal procedures included the following: 29 primary Silastic medializati ons, 3 primary Silastic medializations with arytenoid adduction, 53 se condary Silastic medializations, 4 secondary Silastic medializations w ith arytenoid adduction, and 11 bilateral Silastic medializations. The se procedures arc useful in treating unilateral true vocal cord paraly sis, scarring, bowing, or paresis, as well as bilateral true vocal cor d bowing. Of the initial 100 patients, 16 later underwent a revision w ith either a larger implant's being placed or an arytenoid adduction. Primary Silastic medialization is the placement of an implant under ge neral anesthesia in the same surgical setting in which laryngeal inner vation is sacrificed. Secondary Silastic medialization is the placemen t of an implant under local anesthesia for a preexistent vocal cord ma lfunction. In either case, overall voice results for unilateral paraly sis are very good. Primary Silastic medialization significantly decrea ses the postoperative rehabilitation period in skull base patients bec ause of the immediate postoperative glottal competence and decreased u se of perioperative tracheotomy. Bilateral implants yielded good resul ts in 6 patients with presbylaryngis, but 6 other patients with bowing from other causes experienced only moderate improvement in speech qua lity. There were no implant extrusions; however, 1 implant was removed secondary to a persistent laryngocutaneous fistula in a patient who h ad previously undergone laryngeal irradiation. This was the only compl ication in this series.