Medialization Laryngoplasty After Endoscopic Laser Cordectomy. Our Experience

Published:October 26, 2020DOI:



      Medialization laryngoplasty can be performed to treat glottic incompetence after endoscopic laser cordectomy. The aim of this study is to evaluate vocal outcome after this phonosurgical procedure and to analyze the critical aspects of the Montgomery and Gore-Tex laryngoplasty technique.


      A retrospective observational study of patients with glottic incompetence after endoscopic laser cordectomy, underwent medialization laryngoplasty with Montgomery or Gore-Tex implant between January 2013 to December 2018 at the Bufalini Hospital of Cesena, Italy. The pre- and postphonosurgery evaluation included videolaryngostroboscopy, perceptual, evaluation of dysphonia with the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, Voice Handicap Index-10, Maximum Phonation Time. The outcome was evaluated 6 months after the phonosurgical treatment.


      We treated 22 patients, 19 males and 3 females. Eight cases were treated with Montgomery implant and fourteen with Gore-Tex implant. The postphonosurgical videolaryngostroboscopy showed an improvement of the glottic closure in all patients; the scores of the Voice Handicap Index-10 and of the Maximum Phonation Time showed a statistically significant improvement after phonosurgery. The GRBAS scale scores showed a statistically significant improvement of Global Grade, Breathiness, and Asthenia; the parameter Strain remained unaltered both in pre- and postoperative evaluations, because the voice was never pressed due to glottic insufficiency, especially in preoperative observation. The parameter Roughness (R) did not show a significant difference between pre- and postoperative evaluation.


      Medialization laryngoplasty is an effective phonosurgical procedure to improve voice outcome, after extended endoscopic laser cordectomies, in patients with unacceptable results after voice therapy and injection laryngoplasty. In our experience the Gore-Tex implant allows the surgeon to perform a safer and more “tailored” phonosurgery in cases of cordectomies type IV and V, associated or not with radiotherapy and in revision surgery.

      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


        • Peretti G
        • Piazza C
        • Balzanelli C
        • et al.
        Preoperative and postoperative voice in Tis-T1 glottic cancer treated by endoscopic cordectomy: an additional issue for patient counseling.
        Ann Otol Rhinol Laryngol. 2003; 112: 759-763
        • Peretti G
        • Piazza C
        • Balzanelli C
        • et al.
        Vocal outcome after endoscopic cordectomies for Tis and T1 glottic carcinomas.
        Ann Otol Rhinol Laryngol. 2003; 112: 174-179
        • Isshiki N
        • Morita H
        • Okamura H
        • et al.
        Thyroplasty as a new phonosurgical technique.
        Acta Otolaryngol (Stockh). 1974; 78: 451-457
        • Friedrich G
        • de Jong FI
        • Mahieu HF
        • et al.
        Laryngeal framework surgery: a proposal for classification and nomenclature by the Phonosurgery Committee of the European Laryngological Society.
        Eur Arch. 2001; 258: 389-396
        • Ramacle M
        • Lawson G
        • Hedayat A
        • et al.
        Medialization framework surgery for voice improvement after endoscopic cordectomy.
        Eur Arch Otorhinolaryngol. 2001; 258: 267-271
        • Zeitels SM
        • Mauri M
        • Dailey SH
        Medialization laryngoplasty with Gore-Tex for voice restoration secondary to glottal incompetence: indications and observations.
        Ann Otol Rhinol Laryngol. 2003; 112: 180-184
        • Remacle M
        • Eckel HE
        • Antonelli A
        • et al.
        Endoscopic cordectomy. A proposal for a classification by the working committee, European laryngological society.
        Eur Arch Otorhinolaryngol. 2000; 257: 227-231
        • Dejonckere PH
        • Bradley P
        • Clemente P
        • et al.
        A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the committee on phoniatrics of the European laryngological society (ELS).
        Eur Arch Otorhinolaryngol. 2001; 258: 77-82
        • Ricci-Maccarini A
        • Bergamini G
        • Fustos R
        Proposal of a form for the collection of videolaryngostroboscopy basic findings.
        Eur Arch Otorhinolaryngol. 2018; 275: 1927-1933
        • Forti S
        • Amico M
        • Zambarbieri A
        • et al.
        Validation of the Italian voice handicap index-10.
        J Voice Off J Voice Found. 2014; 28 (263.e17-263.e22)
        • Hirano M
        Clinical examination of voice.
        in: Arnold GE Winckel F Wyke BD Disorders of Human Communication. Springer, New York1981: 81-84
        • Mastronikolis NS
        • Remacle M
        • Kiagiadaki D
        • et al.
        Medialization thyroplasty for voice restoration after transoral cordectomy.
        Eur Arch Otorhinolaryngol. 2013; 270: 2071-2078
        • Piazza C
        • Bolzoni Villaret A
        • Redaelli De Zinis LO
        • et al.
        Phonosurgery after endoscopic cordectomies. II. Delayed medialization techniques for major glottic incompetence after total and extended resections.
        Eur Arch Otorhinolaryngol. 2007; 264: 1185-1190
        • Sittel C
        • Friedrich G
        • Zorowka P
        • et al.
        Surgical voice rehabilitation after laser surgery for glottic carcinoma.
        Ann Otol Rhinol Laryngol. 2002; 111: 493-499
        • Bertelsen C
        • Reder L.
        Efficacy of type I thyroplasty after endoscopic cordectomy for early-stage glottic cancer: literature review.
        Laryngoscope. 2018; 128: 690-696
        • Ricci-Maccarini A
        • De Rossi G
        • Pieri F
        • et al.
        Bergamini G Presutti L Molteni G Springer International Publishing, Cham2015: 51-65
        • McCulloch TM
        • Hoffman HT
        • Andrews BT
        • et al.
        Arytenoid adduction combined with Gore-Tex medialization thyroplasty.
        Laryngoscope. 2000; 110: 1306-1311
        • Shah RN
        • Deal AM
        • Buckmire RA
        Multidimensional voice outcomes after type I Gore-Tex thyroplasty in patients with nonparalytic glottic incompetence: a subgroup analysis.
        Laryngoscope. 2013; 123: 1742-1745