31591 Laryngoplasty, medialization, unilateral

Name of the Procedure:

Laryngoplasty, medialization, unilateral (also known as Thyroplasty Type I, Medialization Thyroplasty, or Vocal Cord Medialization)

Summary

Laryngoplasty, medialization, unilateral is a surgical procedure aimed at repositioning one of the vocal cords closer to the center of the larynx. This is done to improve voice quality and to help prevent aspiration of liquids into the lungs.

Purpose

Medical Condition Addressed:

• Vocal cord paralysis or paresis (weakness)
• Vocal cord atrophy or bowing

Goals or Expected Outcomes:

• Improved voice quality (louder, clearer speech)
• Enhanced ability to swallow and reduce the risk of aspiration

Indications

Symptoms:

• Hoarse or breathy voice
• Difficulty speaking loudly
• Frequent choking or coughing while eating or drinking

Patient Criteria:

• Diagnosed with unilateral vocal cord paralysis or significant vocal cord weakness that affects voice and swallowing functions

Preparation

Pre-Procedure Instructions:

• Fasting for at least 6 hours before surgery
• Adjustments or temporary cessation of certain medications (e.g., blood thinners)
• Preoperative assessment including blood tests and electrocardiogram (ECG)

Diagnostic Tests:

• Laryngoscopy to evaluate vocal cord movement
• Voice analysis tests

Procedure Description

1. Under anesthesia, an incision is made in the neck at the level of the thyroid cartilage.
2. A small window is created in the cartilage.
3. An implant made of silicone or other biocompatible material is inserted to push the paralyzed vocal cord towards the center.
4. The incision is closed with sutures.

Tools and Equipment:

• Surgical scalpel, laryngoscope, specialized implants for medialization

Anesthesia:

• General anesthesia or local anesthesia with sedation

Duration

Typically takes about 1 to 2 hours.

Setting

Performed in a hospital or surgical center.

Personnel

• ENT (Ear, Nose, and Throat) Surgeon or Laryngologist
• Anesthesiologist
• Surgical Nurses

Risks and Complications

Common Risks:

• Infection at the incision site
• Swelling or bruising

Rare Complications:

• Migration or extrusion of the implant
• Persistent hoarseness or vocal changes
• Breathing difficulties
• Need for revision surgery

Benefits

• Improved voice quality immediately or within a few days
• Better control over swallowing
• Enhanced overall quality of life

Recovery

Post-Procedure Care:

• Mild to moderate pain managed with prescribed analgesics
• Avoid strenuous activities and heavy lifting for at least a week
• Follow-up appointment within one to two weeks for evaluation

Recovery Time:

• Full recovery typically within a few weeks
• Voice rest may be recommended initially

Alternatives

Other Treatment Options:

• Voice therapy (speech therapy)
• Injection laryngoplasty (temporary or permanent filler injections)
• Observation for spontaneous nerve recovery

Comparison:

• Voice therapy is non-invasive but may not be effective for severe cases.
• Injection laryngoplasty is less invasive but may require repeated treatments.

Patient Experience

During the Procedure:

• If under local anesthesia, minimal discomfort; under general anesthesia, no awareness during surgery.

After the Procedure:

• Expect some pain at the incision site and mild sore throat.
• Gradual improvement in voice quality notable within days.
• Prescribed medications for pain and instructions to care for the surgical site.