Medialization laryngoplasty with strap muscle transposition for vocal fold atrophy with or without sulcus vocalis

OBJECTIVE: Vocal fold atrophy with or without sulcus vocalis may result in a spindle-shaped glottal incompetence (SGI). Because of varying drawbacks with all existing materials (e.g., Silastic block, Teflon, fat, etc.) used for medialization or augmentation of the atrophic vocal folds, there is a need to supplant these materials with a more stable, autologous tissue to correct the SGI. STUDY DESIGN: Thirty-two patients with vocal fold atrophy underwent medialization laryngoplasty with strap muscle transposition. METHODS: Under local or general anesthesia, the thyroid lamina on the more affected side was vertically incised 5 mm off the midline. The inner perichondrium was carefully elevated from the overlying thyroid ala. Care was taken not to enter the laryngeal lumen. After dividing the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally. To accommodate the muscle flap more easily, the caudal edge of the lamina was trimmed using a small burr. A bipedicled strap muscle flap was then transposed into the space between the lamina and the paraglottic soft tissue. The thyroid cartilages were carefully sutured back in place. All patients underwent pre- and postoperative voice evaluations including laryngostroboscopy, perceptual assessment, and acoustic and aerodynamic analyses. Patients who had been followed up for more than 3 months were enrolled in this study. RESULTS: A total of 27 of the 32 patients with complete pre- and postoperative voice function measurements were included in the analysis. Vocal improvement was demonstrated in 26 of these 27 (96%) patients. No dyspnea or other major complications were noted in any patients. CONCLUSION: The results indicate that medialization laryngoplasty with strap muscle transposition is a prosthesis-free, safe, and effective technique for correcting SGI caused by vocal fold atrophy.