Combination of direct pull of lateral cricoarytenoid muscle and thyroplasty type I for severe unilateral vocal cord paralysis

Techniques and the outcome of our approach that combined two operations, a direct pull of the lateral cricoarytenoid muscle (LCA-Pull) and Isshiki's thyroplasty type I are reported. LCA-Pull is very simple and allows natural adduction of arytenoid by pulling LCA. The subjects were five patients whose maximal phonation time (MPT) were under 5 seconds. All patients achieved MPT over 13 seconds. Mean flow rates (MFR) varied from 340ml/s to over 1000 ml/s before the operation. In all patients, the post operative MFR improved to under 150 ml/s. Sometimes severe unilateral vocal cord paralysis requires both arytenoid adduction and medialization thyroplasty to obtain good voice. Combination of LCA-Pull and thyroplasty type I is very effective for severe case, and could be done in the same operating field by creating an additional window in the thyroid ala.