• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.6 no.1
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• pp.39-42
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• 1995

Surgical treatment options of symptomatic unilateral vocal fold paralysis are Teflon injection, type Ⅰ thyroplasty, and arytenoid adduction. Arytenoid adduction is preferable to type Ⅰ thyroplasty for correcting the level different that may be present between two vocal folds and the large glottal chink However there is no known therapeutic modality effective to correct the large posterior glottal chink of the vocal fold with relatively normal mobility. Recently we have experienced a case of severe large posterior glottal chink of the vocal 1314s with relatively normal mobility after thyroid lobectomy, successfully treated with type Ⅰ thyroplasty combined with arytenoid adduction.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.1
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• pp.11-15
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• 2007

Background and Objectives: $VoCoM^{(R)}$ is a set composed of prefabricated hydroxylapatite implants and shims of various sizes that are designed for the type I thyroplasty, Authors aimed to evaluate the efficacy of $VoCoM^{(R)}$ System in type I thyroplasty. Materials and Method: Twenty three patients with unilateral vocal cord palsy were included in the study, who received type I thyroplasty with $VoCoM^{(R)}$ between May 2000 and May 2007 in St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea, Acoustic, aerodynamic and stroboscopic analyses were performed pre-and post-operatively, Subjective voice improvement was analysed by Voice handicap index, Results : Preoperative jitter was $4.68{\pm}2.46%$ and improved to $3.19{\pm}1.94%$(P<0,05), Preoperative NHR was $0.26{\pm}0.1$ and improved to $0.18{\pm}0,07$(P<0.05), Preoperative MPT was $6.16{\pm}4.9$secs improved to $9.55{\pm}4.67$secs(p<0.05), The postoperative stroboscopy revealed an effective medialization of vocal fold of all patients, Conclusion: Type I thyroplasty using $VoCoM^{(R)}$ is a efficient, safe and convenient way of vocal fold medialization at the expense of its high cost and difficulty in removal.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.1
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• pp.7-10
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• 2007

Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. The treatment of unilateral vocal cord paralysis has a long history, marked by technical innovations and improvements. These methods typically use endoscopic injection or implants to augment the volume of the affected vocal fold. The first known treatment, reported by Brunnings in 1911, was paraffin injection. The first thyroplasty medializing the paralysed vocal cord was performed by Payr in 1915 ; here, a cartilage door-flap was created from the thyroid ala to obtain better voice quality. In the 1970s, Isshiki systematized and developed the use of the external medialization by Payr. Later he modified his original technique, and achieved safer and better results. Many other methods were introduced for external medialization during the 1980s and 1990s. There has been couple of materials using for medialization laryngoplasty: silicone bloc, cartilage, goretex (polytetrafluoroethylene), titanium, etc. Among them, silicone bloc is the most popularly used material. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralysed vocal fold. In this paper, personal experience for using silicone bloc type I thyroplasty : decision making and practical points, long-term results and complication of the procedure will be discussed.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.1
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• pp.33-37
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• 1997

Incomplete glottic closure of vocal cord atrophy is the common cause of dysphonia. Patients with vocal cord atrophy have complaints such as dysphonia, vocal fatigue, abnormal sensation in the throat, laryngeal pain, cough or sputum like functional voice disorders. Many investigators could not confirm the pathologic laryngeal structure because of their minute pathology. But recent advancements of laryngeal examinations made the many clinicians to detect minimal laryngeal pathology and to have mind the treatment for the vocal cord atrophy. But the results were less effective than their thoughts, the reasons of ineffectiveness were not known well. Authors have found the Hyperfunctional movement of the supraglottis during phonation before and after thyroplasty type I for vocal cord atrophy. Then we have applied the combined modality treatment with thyroplaty type I and voice therapy for relieve of hypefunctional movement of the supraglottis. These options have had more imporved results.

• Korean Journal of Head & Neck Oncology
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• v.14 no.1
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• pp.27-34
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• 1998

Objectives, Materials & Methods: To prevent deterioration of postoperative voice due to iatrogenic transection of the recurrent laryngeal nerve during the thyroid surgery, intraoperative medialization of the membranous vocal cord by type I thyroplasty together with direct epineurial neurorraphy was done on 2 cases of benign thyroid lesion. To improve the quality of voice together with complete removal of advanced thyroid carcinoma, intraoperative vocal cord medialization on the lesion side together with total thyroidectomy was done by type I thyroplasty in 2 cases and combined procedure by arytenoid adduction and type I thyroplasty in another 2 cases. Results: The resultant voice of the iatrogenic injury cases was relatively tolerable. The voice of the combined procedure was better than that of type I thyroplasty cases for the intraoperative rehabilitation cases. Not only for the preoperative evaluation of the severity of the nerve lesion but also the prognosis will be expected by use of laryngeal EMG in the cases of thyroid cacer with vocal cord palsy. Conclusion: Intraoperative simultaneous rehabilitation for the vocal cord palsy during thyroid surgery is beneficial for the patients.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.1
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• pp.66-70
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• 1998

Background and Objectives : The managements of unilateral vocal cord palsy include type Ⅰ thyroplasty and arytenoid adduction. One type operation has been shown no satisfactory effect. We evaluated preoperative and postoperative speech of unilateral vocal cord palsy patients who received combined operation of type Ⅰ thyroplasty and arytenoid adduction to help for the management plan of unilateral vocal cord palsy patients. Materials and Methods : We reviewed the postoperative results and complication of 17 surgically treated patients of unilateral vocal cord palsy at Severance hospital from Nov. 1996 to Dec. 1997 retrospectively. They were received combined operation of type Ⅰ thyroplasty and arytenoid adduction. Their pre and post-operative speech were analyzed with MDVP(Multi-Dimension-Voice analysis Program) of CSL(Computerized Speech Lab). Results : After the operation, MPT(Maximal Phonation Time) was increased and MFR(Mean Flow Rate) was decreased in all patients. NHR(Noise to Harmonic Ratio) and VTI(Voice Turbulence Index) were decreased : liner, RAP(Relative Average Perturbation Quotient), PPQ(Pitch Period Perturbation Quotient), sPPQ(smoothed Pitch Period Perturbation Quotient), vFo(fundamental frequency Variation) were decreased : Shimmer, APQ(Amplitude Perturbation Quotient), sAPQ(Smoothed Amplitude Perturbation Qoutient), vAm(Peak Amplitude Variation) were decreased in all the patients. Conclusions : In unilateral vocal cord pals), combined operation of type Ⅰ thyroplasty and arytenoid adduction could obtain satisfactory postoperative voice. MDVP has many parameters and good method for evaluation of voice surgery.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.2
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• pp.117-122
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• 2003

Background and Objectives : $VoCoM^{\circledR}$ is a commercialized set composed of prefabricated hydroxylapatite implants and shims of various sizes which are specially designed for the type I thyroplasty. Even though a previously published preliminary report showed that $VoCoM^{\circledR}$ is a convenient and safe product for the type I thyroplasty, further investigations or experiences are yet to be reported. Authors aimed to evaluate the efficacy of $VoCoM^{\circledR}$type I thyroplasty, and its advantage and/or disadvantage. Materials and Method : Twenty three consecutive patients with unilateral vocal cord palsy enrolled for the study, who received type I thyroplasty with $VoCoM^{\circledR}$ between July 2001 and June 2003. Acoustic, aerodynamic and stoboscopic analyses were performed prior to surgery and 1 to 3 months after surgery. Speech language pathologists evaluated their voice quality by GRBAS scale, and patients themselves reported subjective changes of their voice by visual analog scale. Results : The average time for the operation was 80 min, which is about 30 min less than other methods. Preoperative jitter was 3.25$\pm$1.65% and improved to 1.94$\pm$1.79% postoperatively (p<0.05). Preoperative shimmer was 9.72$\pm$6.56% and improved to 5.61 $\pm$3.76% (p<0.05), Maximal phonation time increased from 4.41$\pm$2.99 to 7.98$\pm$4.35 sec (p<0.05) The postoperative stroboscopy revealed an effective medialization in 91.3% of the patients. The subjective phonetic improvements were reported in 21 out of 23 patients. GRBAS scale improved from 2.71$\pm$0.46 to 1.47$\pm$1.12(p<0.05). Additional medialization with $Gore-Tex^{\circledR}$ was easily performed in two revision cases. Previously inserted $VoCoM^{\circledR}$ implant was hard to remove because of the tight integration of soft tissues around the implant. Side effects such as extrusion or foreign body reaction are not observed. $VoCoM^{\circledR}$ was relatively expensive and costed more than 10 times of $Gore-Tex^{\circledR}$. Conclusion : Prefabricated hydroxylapatitie implant($VoCoM^{\circledR}$) provides a convenient, safe and efficient way of vocal fold medialization. However it is relatively expensive and hard to remove.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.7 no.1
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• pp.5-10
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• 1996

From October 1991 to June 1995, 4 medialization thyroplasties and I arytenoid adduction were simultaneously performed with the thyroid surgery when the unilateral recurrent laryngeal nerve was paralyzed before or during thyroidectomy. Four cases were papillary carcinoma with direct invasion to the unilateral recurrent laryngeal nerve, and one case was huge adenomatous goiter and the recurrent laryngeal nerve was incidentaly cut. Hoarseness was present preoperatively with mean duration of 15 months and aspiration was also present in three cases. After phonosurgery, voice was improved in 4 out of 5 cases and aspiration subsided in 2 out of 3 cases. In one case, hoarseness continued after total thyroidectomy and thyroplasty type I and the arytenoid adduction with planned due to posterior glottic gap of 2mm. We suggest that the thyroplasty type I or arytenoid adduction are primary phonosurgical procedures which ran be performed concomitantly with neck surgeries in the patients with paralysis of the unilateral recurrent laryngeal or vagus nerve damage during neck surgeries.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.10.1-10
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• 1982

The use of phonosurgery in the recent development of laryngomicrosurgery has enabled the restoration of a normal voice in respect to functional laryngeal surgery which in Korea in the past limited to simple removal of benign laryngeal tumor such as laryngeal polyp or nodules and cordal injection of $Teflon^{{\circledR}}$ for the treatment of recurrent nerve paralysis under the vision of suspension laryngoscopy. Performance of phonosurgery for the treatment of cord paralysis, mutational dysphonia, vocal cord atrophy, hyperkinetic dysphonia and sulcus vocalis is a happy event in the view point of development of phonosurgery in Korea. In this aspect thyroplasty to change the position and physical characteristics of the cord outside the glottis instead of the direct handling of the vocal cord through direct endoscopy is popular. Among the 4 types of thyroplasty, classified by Insshiki(1974), type I thyroplasty(1ateral compression of vocal cord) and type IV thyroplasty(lengthening of vocal cord) were effective in the treatment of unilateral vocal cord paralysis. Advantages of this operation are the fine adjustment of the degree of lateral compression under local anesthesia according to the phonation of the patient during operation and avoidance of dyspnea and intralaryngeal hemorrhage due to the manipulation outside the internal perichondrium of the thyroid cartilage. We did 7 cases of thyroplasty for the treatment of unilateral vocal cord paralysis in the 7 months from September 1981 to March 1982. Before the operation aerodynamic study, psychoacoustical evaluation, stroboscopy and sound spectrographic analysis were done. Two months after the operation the above procedures were performed again. Results of preoperative and postoperative examination were compared and the following results were obtained. 1) In the aerodynamic study, maximum phonation time increased to 158% of the preoperative value and the phonation quotient and the mean flow rate decreased to 58% and 54% of preoperative values. 2) The degree of hoarseness improved in the psychoacoustical evaluation and the glottic chink during phonation was decreased in the stroboscopic examiantion. 3) In the sound spectrographic analysis, periodicity was much restored and noise distribution decreased especially in the high frequency area.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.1
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• pp.16-20
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• 2004

Purpose : To assess perceptual, acoustic and aerodynamic measure of voice quality in patients with unilateral vocal cord paralysis before and after type I thyroplasty. Methods : The clinical records of patients operated type I thyroplasty in the Departement of otorhinoalryngolgy, Yongdong Severance hospital from November 2001 to November 2003 were reviewed. All patients uderwent a vocal function evaluation including perceptual, acoustic and aerodynamic measures of voice preoperative and on $60^{th}$ postoperative day. The perceptual and acoustic measures were obtained from recording of patients' reading a 'Sanchak' passage. The perceptual evaluation was performed by 2 speech pathologist using a 4-point rating scale. Acoustic parameters(voice range profile low(RAL), voice range profile high(RAH), average fundamental frequency(AFX), closed quotient, harmonic to noise ratio, jitter and shimmer) were investigated by Lx speech studio. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured using the Phonatory function analyzer. The maximum phonation time was also measured. The data were statistically analyzed. A paired t-test (p<0.1) was used to compare preoperative and postoperative results. And multiple regression test was used to find which parameter was most correlated to improvement of postoperative voice quality. Results : Among aerodynamic parameters, Psub $(88.11mmH_2O{\rightarrow}58.7mmH_2O)$, MPT(7.87sec${\rightarrow}$12.53sec), MFR (359.8ml/sec${\rightarrow}$161.06ml/sec) were statistically improved. AFx(205.5Hz${\rightarrow}$163.27Hz), AQx(23.9%${\rightarrow}$48.3%), RAL, RAH. Jotter and shimmer were improved. In multiple regression test, AFx and AQx was noted as the two meost correlated parameters to improvement of postoperative breathiness. But general grade of voice quality was more correlated to Psub and shimmer. Conclusion : Vocal fold medialization procedures effectively reduce glottic gap. Increasing of contact area of both vocal folds induced improvement in aerodynamic parameters and leaded stabilizing of vocal fold vibration. That effect results in improvement in acoustic parameters (shimmer, jitter, signal-to-noise ratio, voice range profile) and voice quality.