Revision Type 2 Thyroplasty to Reduce Dilatation Width to Less than 2.0 mm

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  • Miura Reo
    Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine
  • Nakamura Kazuhiro
    Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine
  • Suzuki Hirotaka
    Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine
  • Oshima Takeshi
    Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine

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Other Title
  • 甲状軟骨形成術2型の再手術において開大幅2.0mm以下にする工夫
  • コウジョウナン コツ ケイセイ ジュツ 2ガタ ノ サイシュジュツ ニ オイテ カイオオハバ 2.0mm イカ ニ スル クフウ

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Abstract

<p>Adductor spasmodic dysphonia (AdSD) is local dystonia caused by involuntary contraction of the thyroarytenoid muscle during speech. The usefulness of type 2 thyroplasty (TP2) using a titanium bridge (TB) has been reported. The minimum standard size of the retailed TB is 2.0 mm, and it has been recommended that two TBs should be placed in the cranial and caudal sides of the space between the bilateral divided thyroid cartilages. We experienced a female patient with insufficient voice loudness after a long period since the performance of TP2. A female patient in her thirties presented with a voice break of speech and was diagnosed as AdSD. TP2 was performed, with a dilatation width of 2.0 mm in the space between the divided thyroid cartilages using two TBs. After the TP2, her speech disorder improved but she complained of weak voice for three years, and she came to us for a second TP2. Intraoperative findings showed nothing particularly amiss with the caudal TB ; the cranial TB was damaged at the left and right wing holes, but the width of the TB opening was maintained at 2.0 mm. After removing both TBs, voice deterioration was confirmed. In order to reduce the opening width to 2.0 mm or less, a TB with a widened width of 2.0 mm was used only on the caudal side. The width of the dilatation was 2.0 mm on the caudal side, about 1.5 mm at the anterior commissure, and about 1.0 mm on the cranial side. The mora method was 0/21, G0. Voice volume increased and was maintained for 14 months after the reoperation. It is standard procedure to use two TBs. However, by using a TB with a dilatation width of 2.0 mm only on the caudal side, we were able to reduce the dilatation width to less than 2.0 mm. It is not recommended to use one TB, although it was considered to be a useful method when the width of the dilatation is too wide even at 2.0 mm after revision type 2 thyroplasty. </p>

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