Featured Video: Thyroplasty for Vocal Cord Paralysis

Presented by Dr. James DuCanto, M.D., Aurora St. Luke's Medical Center.

The laryngeal framework surgery (LFS) is the surgery of choice for dysphonias resulting from incomplete glottic closure or inadequate vocal fold tension. The medialization (Type I) thyroplasty is most commonly performed for a unilateral vocal cord (VC) paralysis, as in the presented patient. It does not involve surgery on the VC per se, thus avoiding the possibility of scarring and voice aggravation.
 

The presented video outlines the important steps of the procedure. Both surgical approaches and anesthetic techniques differ, however. Some surgeons perform the procedure “blindly”, relying on the perceived improvement of the voice quality by the patient intraoperatively. Others, as in this video, like to confirm this subjective improvement by visualizing the improved position of the VC. Yet, others elect to perform this surgery under general anesthesia.
 

Please share your thoughts on the video and the practice of thyroplasty in your institution. What anesthetic techniques do you favor? What special anesthetic considerations may apply to these patients should they require general endotracheal anesthesia in the future?