Arytenoid adduction combined with Gore-Tex medialization thyroplasty

Objective: To describe the technique of combined Gore-Tex medialization thy roplasty with arytenoid adduction and to determine the long-term vocal outc ome of patients treated for unilateral vocal cord paralysis with this proce dure. Study Design: A retrospective chart review and patient reevaluation f or patients treated at The University of Iowa Hospitals and Clinics between May 1995 and June 1999, Methods: The review addressed patient demographics , perioperative and long-term complications, and voice outcomes. Details of the surgical technique are provided within the manuscript. Results: Sevent y-two Gore-Tex medialization procedures were completed. Arytenoid adduction was included in 22 of these procedures. This subset of patients was compar ed with the patients treated with Gore-Tex alone. No major postoperative co mplications occurred in either group. Preoperative and postoperative voice and videostroboscopy data were available for 19 arytenoid adduction patient s and 25 Gore-Tex alone patients. On a seven-point scale (6 [severely abnor mal] --> 0 [normal voice]), the average patient rating of voice dysfunction improved from 4.2 to 1.6 (arytenoid adduction) and 4.5 to 2.8 (Gore-Tex al one). Maximum phonation time improved from 6.9 seconds to 16.7 seconds in t he arytenoid adduction group. Subjective voice assessment employing the fou r-point GRBAS scale (3 [severely abnormal] --> 0 [normal]) identified avera ge improvement from an overall grade of 2,1 to 0.8 arytenoid adduction and 2.2 to 1.5 in the Gore-Tex alone group. Improvement was identified in the v ocal quality of breathiness from 1.9 to 0.2 (arytenoid adduction) and 1.9 t o 0.9 (Gore-Tex alone). Conclusions: The combined technique of Gore-Tex med ialization thyroplasty and arytenoid adduction provide functional results t hat appear to exceed the improvement attained with medialization alone.