Thyroplasty

What is Thyroplasty?

Thyroplasty is a surgical treatment method used in some diseases that cause hoarseness. This surgery aims to treat voice disorders by making changes in cartilage structures, especially the thyroid cartilage, which contains the vocal cords and is located in the middle of the neck.

What are the Types of Thyroplasty?

There are many types of thyroplasty, as all surgeries performed on the laryngeal skeleton are usually called “thyroplasty” and may be performed in combination with some other surgeries. In the broadest classification, thyroplasty can be divided into 4 types:

Type 1 thyroplasty (Medialization Laryngoplasty): This surgery aims to bring the vocal cords closer to the midline. It can be used in all cases that prevent the vocal cords from approaching the midline, especially in unilateral vocal cord paralysis. These include sulcus vocalis, vocal cord scarring, vocal cord paresis and tissue loss due to radiation or cancer treatment.

Type 2 thyroplasty (Lateralization Laryngoplasty): This surgery aims to move the vocal cords away from the midline. This surgery is often used as a treatment for advanced stages of spasmodic dysphonia.

Type 3 thyroplasty (Relaxing Laryngoplasty): A surgical technique that aims to thicken the voice by reducing the tension in the vocal cords.

Type 4 tiroplasty (Tensioning Laryngoplasty): A surgical technique aimed at thinning the voice by increasing the tension of the vocal cords.

Are the Results of Tiroplasty Surgery Temporary or Permanent?

Since structural changes are made to the cartilage that forms the larynx during tiroplasty, the results are permanent.

What Are the Differences Between Tiroplasty and Vocal Cord Injection?

Tiroplasty is an open surgery, meaning an incision is made in the neck, and the skin, subcutaneous tissue, and neck muscles are passed through to reach the laryngeal cartilages. The surgery primarily involves these cartilages. Vocal cord injection, on the other hand, is a procedure in which certain substances found in the body are injected into the vocal cords in liquid form using appropriate needles. The injection can be performed by reaching the vocal cords through the mouth, nose, or skin, without the need for an incision, under local or general anesthesia. While the injection can be done in an operating room or office setting, tiroplasty surgery can only be performed in an operating room.

For Which Voice Disorders Is Type 1 Tiroplasty Performed?

Type 1 tiroplasty is most commonly performed in cases of unilateral vocal cord movement restriction (vocal cord paralysis). In this voice disorder, one of the vocal cords cannot move, preventing the vocal cords from touching during speech. With Type 1 tiroplasty, the immobile vocal cord is brought closer to the moving one, allowing proper contact. This contact improves voice quality, positively affects its continuity, and reduces fatigue. Similarly, type 1 tiroplasty can be applied in cases of vocal cord movement restriction (paresis), vocal cord groove (sulcus vocalis), vocal cord tissue loss due to surgeries, accidents, or radiation. In cases of age-related hoarseness (presbyphonia) and vocal cord muscle atrophy, type 1 tiroplasty is also a solution that improves voice quality.

Is Type 1 Tiroplasty Performed Under General Anesthesia or Local Anesthesia?

When performed alone, type 1 tiroplasty can be performed under local anesthesia in the operating room. The purpose and benefit of local anesthesia are to allow the patient's voice to be heard during the surgery. Type 1 tiroplasty can also be successfully performed under general anesthesia, depending on the technique, other surgeries to be performed, the patient, and the related clinic.

Who Performs Tiroplasty Surgery?

Tiroplasty surgeries are performed by ENT specialists trained in the diagnosis and treatment of voice disorders (phoniatrists – laryngologists).

What Types of Implants Are Used in Type 1 Tiroplasty?

In type 1 thyroplasty, different types of implants can be used to reposition the vocal cords in the midline. The most commonly used of these are silastic implants. Medical silastic is shaped by the surgeon to fit the patient. Another commonly used implant is polytetrafluoroethylene vascular grafts. Commercial implant types produced in different sizes are also available as thyroplasty implants.