Laryngeal Dystonia - Thyroplasty

Thyroplasty surgeries include a group of surgical techniques to modify the cartilage surrounding the larynx. These adjustable and reversible procedures involve manipulating the cartilage by implanting wedges or shims to hold the tissue in place. A number of variations of this procedure are currently used and are effective for restoration of the voice after paralysis or in changing the pitch of the voice.

Type I thyroplasty has been used for the abductor variety of spasmodic dysphonia/laryngeal dystonia.  In this procedure, the vocal cords are brought closer together in hopes of decreasing the effect of the abductor spasms. Results are mixed, with some patients getting good relief, and others having minimal effect.

Type II thyroplasty is a procedure for adductor spasmodic dysphonia that involves spreading the vocal cords apart by inserting a shim that prevents them from contacting each other during the spasms that occur with this disorder. Although some have reported good relief of vocal strain, others feel the trade off to a breathy and weak voice is too excessive.

Researchers in the US and abroad continue to investigate thyroplasty procedures. The advantage of these procedures is that they are largely non-destructive and do not alter the muscles or nerve supply of the larynx. They work through adjustment of biomechanics alone and are theoretically reversible, although in practice the reversibility may be limited by scarring.

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