Short- and Long-Term Outcomes After Silastic Medicalization Laryngoplasty: Are Arytenoid Procedures Needed?

Published:December 12, 2014DOI:



      To evaluate short- and long-term vocal outcomes after medialization laryngoplasty (ML) using a silastic implant in patients with unilateral vocal fold paralysis (UVFP).

      Design and Methods

      Prospective study of consecutive patients undergoing ML with silastic (MLS) diagnosed with UVFP from 2009 till 2012 and with at least 9 months follow-up. Pre- and post-treatment maximum phonation time (MPT) and voice handicap index (VHI) scores were compared to assess the impact of ML on these outcomes. Patients with high vagal lesions or lateralized vocal folds (very low MPT) were compared with the entire group and the literature.


      A total of 124 patients with UVFP underwent MLS. Forty-six patients were excluded as they either had a Gore-Tex implant (eight), short follow-up (20), or the primary case was a revision (18). Seventy-eight patients were included. Pretreatment mean VHI (total score) was 67 for the entire cohort. Postoperative VHI score was significantly lower both in short-term (3–8 weeks) follow-up, mean score 27 (paired t-test, P < 0.05) and in long-term follow-up (9–12 months), mean score 22 (P < 0.05). MPT was significantly improved from 8.3 pretreatment to 22.6 at short-term follow-up (P < 0.05) and to 24.2 long-term follow-up (P < 0.05). There were no significant differences between entire cohort and patients with a lateralized vocal fold or high vagal lesion. Comparable results were present when compared with the literature using similar metrics in patients undergoing an arytenoid procedure with/without medialization.


      MLS alone is effective in managing UVFP in most patients.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rosenthal-Swibel L.
        • Benninger M.S.
        • Deeb R.H.
        Vocal fold immobility: a longitudinal analysis of etiology over 30 years.
        Laryngoscope. 2007; 117: 1864-1870
        • Spector B.C.
        • Netterville J.L.
        • Billante C.
        • et al.
        Quality-of-life assessment in patients with unilateral vocal cord paralysis.
        Otolaryngol Head Neck Surg. 2001; 125: 176-182
        • Zeitels S.M.
        • Hochman I.
        • Hillman R.E.
        Adduction arytenopexy: a new procedure for paralytic dysphonia with implications for implant medialization.
        Ann Otol Rhinol Laryngol. 1998; 173: 2-24
        • Selber J.
        • Sataloff R.
        • Spiegel J.
        • et al.
        Gore-tex medialization thyroplasty: objective and subjective evaluations.
        J Voice. 2003; 17: 88-95
        • Montgomery W.W.
        • Montgomery S.K.
        Montgomery thyroplasty implant system.
        Ann Otol Rhinol Laryngol. 1997; 106: 1-16
        • Cummings C.W.
        • Purcell L.L.
        • Flint P.W.
        Hydroxylapatite laryngeal implant for medialization. Preliminary report.
        Ann Otol Rhinol Laryngol. 1993; 102: 843-851
        • Friedrich G.
        Titanium vocal fold medializing implant: introducing a novel implant system for external vocal fold medialization.
        Ann Otol Rhinol Laryngol. 1999; 108: 79-86
        • Netterville J.L.
        • Stone R.E.
        • Civantos F.J.
        • et al.
        Silastic medialization and arytenoid adduction: the Vanderbilt experience. A review of 116 phonosurgical procedures.
        Ann Otol Rhinol Laryngol. 1993; 102: 413-424
        • Tsuji D.
        • de Almeida E.
        • Sennes L.U.
        • et al.
        Comparison between thyroplasty type I and arytenoid rotation: a study of vocal fold vibration using excised human larynges.
        J Voice. 2003; 17: 596-604
        • Isshiki N.
        • Morita H.
        • Okamura H.
        • et al.
        Thyroplasty as a new phonosurgical technique.
        Acta Otolaryngol. 1974; 78: 451-457
        • Lundy D.S.
        • Casiano R.R.
        • Xue J.W.
        Can maximum phonation time predict voice outcome after thyroplasty Type I?.
        Laryngoscope. 2004; 114: 1447-1454
        • McCulloch T.M.
        • Hoffman H.T.
        • Andrews B.T.
        • et al.
        Arytenoid adduction combined with Gore-Tex medialization thyroplasty.
        Laryngoscope. 2000; 110: 1306-1311
        • Ryu S.
        • Nam S.Y.
        • Han M.W.
        • et al.
        Long-term voice outcomes after thyroplasty unilateral vocal fold paralysis.
        Arch Otolaryngol Head Neck Surg. 2012; 138: 347-351
        • Laccourreye O.
        • El Sharkawy L.
        • Holsinger C.
        • et al.
        Thyroplasty type I with montgomery implant among native French language speakers with unilateral laryngeal nerve paralysis.
        Laryngoscope. 2005; 115: 1411-1417
        • Hogikyan N.D.
        • Wodchis W.P.
        • Terrell J.E.
        • et al.
        Voice-Related Quality of Life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis.
        J Voice. 2000; 14: 378-386
        • Morgan J.E.
        • Zraick R.I.
        • Griffin A.W.
        • et al.
        Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis.
        Laryngoscope. 2007; 117: 2068-2074
      1. (AHRQ) AfHRaQ. Criteria for determining disability in speech language disorders. Rockville, MD, Evidence Report/Technologic Assessment 202;52.

        • Erkul E.
        • Cincik H.
        • Ural A.
        Extrusion of zgore-tex implant after thyroplasty.
        J Laryngol Voice. 2011; 1: 72-74
        • Lundeberg M.R.
        • Flint P.W.
        • Purcell L.L.
        • et al.
        Revision medialization thyroplasty with hydroxylapatite implants.
        Laryngoscope. 2011; 121: 999-1001
        • Abraham M.T.
        • Gonen M.
        • Kraus D.H.
        Complications of type I thyroplasty and arytenoid adduction.
        Laryngoscope. 2001; 111: 1322-1329
        • Chester M.W.
        • Stewart M.G.
        Arytenoid adduction combined with medialization thyroplasty: an evidence-based review.
        Otolaryngol Head Neck Surg. 2003; 129: 305-310
        • Mortensen M.
        • Carroll L.
        • Woo P.
        Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty: the role of the arytenoidopexy.
        Laryngoscope. 2009; 119: 827-831
        • Ford C.N.
        • Bless D.M.
        • Prehn R.B.
        Thyroplasty as primary and adjunctive treatment of glottic insufficiency.
        J Voice. 1992; 6: 277-285