Accuracy of Thyroid Cartilage Fenestration During Montgomery Medialization Thyroplasty.

Autor: Desuter, Gauthier; Cartiaux, Olivier; Pierard, Jonathan; Henrard, Séverine; van Lith-Bijl, Julie; van Benthem, Peter Paul; Sjögren, Elisabeth

Publication year: 2020

Journal of voice : official journal of the Voice Foundation

issn:1873-4588 0892-1997

doi: 10.1016/j.jvoice.2019.01.005

Abstract:

INTRODUCTION: Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy. MATERIAL AND METHOD: Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS’s instructions for use (the “expected window” (EW)), and comparing it to the actually realized fenestration (the “realized window “(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (°), and (d) the orientation of RW’s center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed. RESULTS: The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16° [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males. CONCLUSIONS: Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients.

Language: eng

Pmid: 30658874

Tags: Humans; Female; Male; Retrospective Studies; Treatment Outcome; Sex Factors; Tomography, X-Ray Computed; Imaging, Three-Dimensional; Recovery of Function; Outcome; Anatomic Landmarks; *Voice; Voice; *Laryngoplasty; Medialization Thyroplasty; Montgomery Implant; Surgical Accuracy; Thyroid Cartilage/diagnostic imaging/physiopathology/*surgery; Unilateral Vocal Fold Paralysis; Vocal Cord Paralysis/diagnostic imaging/physiopathology/*surgery

Link: https://pubmed.ncbi.nlm.nih.gov/30658874/