Complications of type I thyroplasty and arytenoid adduction

Objectives/Hypothesis. Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired spee ch, swallowing, and ability to protect the airway. Type I thyroplasty in co mbination with arytenoid adduction is a proven technique for medialization of the paralyzed vocal fold but must be evaluated in light of potential com plications following laryngeal framework surgery. Study Design and Methods. The charts of 237 patients who underwent unilateral vocal fold medializati on. surgery between July 1, 1991, and August 30, 1999, at a tertiary care c ancer referral center were retrospectively reviewed. Results. There were 98 cases of type I thyroplasty alone and 96 cases of type I thyroplasty with arytenoid adduction. The two groups had similar patient characteristics. Me an time of surgery (45 vs. 73 min, P < .0001) and length of hospital stay ( 1.1 vs. 1.8 d, P < .0001) were increased when arytenoid adduction was perfo rmed. Overall improvement of symptoms was similar in both groups (93%-94%, but posterior glottic closure appeared subjectively improved when arytenoid adduction was used (P =.0054). Overall complication rates were slightly hi gher in the arytenoid adduction group (14% vs. 19%, primarily because of tr ansient vocal fold edema and wound complications (9 vs. 19 cases), but the increase was not statistically significant (P =.1401). Complications warran ting medical or surgical intervention occurred in 8% of cases. Two patients who underwent type I thyroplasty with arytenoid adduction required tracheo tomy as a consequence of postoperative complications. The three patients wh o had extrusion of the implant underwent type I thyroplasty alone. Conclusi on: Using the appropriate technique, the potential benefits of improved glo ttic function following type I thyroplasty with arytenoid adduction outweig h the small risk of significant complications observed.