Thyroplasty Type I

Opening the window on the thyroid cartilage plate and moving the vocal cord on the operation side by opening the window is an important method for treating unilateral recurrent laryngeal nerve palsy. As early as 1915, Payr first made a transverse U-shaped incision on the thyroid cartilage plate to make a cartilage flap in front, pushing the cartilage flap inward to move the vocal cords inward. However, due to the pedicle of the cartilage flap, the internal movement is limited and it has not been promoted. In 1942, Seiffert cut a small piece of cartilage from the costal cartilage of the fresh cadaver. The thyroid cartilage type I (rhyroplasty type I) was the thyroid cartilage fenestration. After that, the procedure was widely used at home and abroad and achieved good results. Some authors have made some improvements to the surgery, but the basic surgery has not changed. Treating diseases: laryngeal trauma Indication The thyroid cartilage type I procedure is also called thyroid cartilage angioplasty type I. The main indications are: 1. Unilateral vocal cord paralysis, the vocal cord on the affected side is fixed in the middle or outreach position, and the patient is ineffective after 6 months of vocal training. 2. The glottic insufficiency after laryngeal trauma or laryngeal surgery. Contraindications 1. Unilateral vocal cord paralysis within 6 months of onset. 2. Those under the age of 10 years old. 3. The contralateral side is accompanied by a person who may have paralysis. 4. The vocal cords are scarred or stiff and cause bad sounds. Preoperative preparation 1. Manual compression test, the examiner points the first 1/3 to the middle 1/3 of the thyroid cartilage wing in the plane of the vocal cords, and the snoring patient sounds to observe the change of the vocal cords during the vocalization. Video changes of the vocal cords were recorded for analysis and postoperative comparison. The hand pressure test has improved sound, and the postoperative effect is also good. No improvement in hand pressure test may be related to the following factors: 1 hand pressure method is wrong, such as improper parts or improper force; 2 thyroid cartilage wings have been calcified, can not be moved inside when pressed; 3 vocal folds or vocal cord atrophic lesions caused by pathological changes in the vocal cords of the vocal cords; 4 improper sounding due to pain during hand pressure test; 5 When the sound is sounded, the glottis is too wide. It may be unsatisfactory to improve the vocalization after surgery due to poor hand sound test. For those who have bad vocalization caused by vocal cord scar or rigidity, the postoperative effect is not good. 2. 0.5 mg of atropine and 0.1 g of phenobarbital were injected half an hour before surgery to reduce the secretions of the throat and keep the patient quiet. Surgical procedure 1. Design skin incision Mark the skin incision before the anesthesia. The upper thyroid cartilage and the lower edge of the thyroid cartilage are marked in the middle respectively. The midpoint between the two points is the incision plane point. The horizontal line of the point on the side of the surgery is the skin incision line. 2. Cut the skin and expose the thyroid cartilage Cut the skin and subcutaneous tissue about 4 to 5 cm along the drawn skin incision, and pull the incision apart. Ligation of the median vein in the neck. Cut vertically in the middle, and bluntly separate the band muscle and connective tissue to the outside along the white line, exposing the thyroid cartilage wing. The surgical side band muscle can be cut or partially cut to make the field wide. The thyroid cartilage is separated from the surface of the thyroid cartilage and the lower edge of the annular cartilage is exposed, exposing the first 2/3 or 3/4 of the thyroid cartilage. 3. Window design The average size of the male window is 6 mm x 12 mm, and the female is 4 mm x 10 mm. From the thyroid cartilage notch to the lower edge of the thyroid cartilage, the vertical height is equivalent to the anterior joint. At this point, a horizontal line is drawn, which is equivalent to the upper surface of the vocal cord and the upper boundary of the fenestration. It is 5 to 7 mm from the midline of thyroid cartilage. 4. Open the window Young or female patients can use a sharp blade to open the window, paying attention not to cut through the inner perichondrium. Adult or male patients with calcification of thyroid cartilage, open the window with a fine electric drill, it is best to cut through 80% to 90% of the full thickness of thyroid cartilage, and the rest is separated by small bone chisel or small stripper (Figure 9.6.4.2.1.4 -5, 9.6.4.2.1.4-6). Do not damage the inner perichondrium during surgery to avoid bleeding and edema of the vocal cords. If there is bleeding during operation, the cotton ball soaked with adrenaline can be used to stop bleeding in the bleeding site, or it can be used to stop bleeding with thrombin powder, hemostatic collagen or fibrin glue. After the window is opened, the cartilage in the window is pressed inward so that the outer surface of the cartilage in the window can reach or exceed the inner side of the thyroid cartilage. If the resistance is large, a small stripper can be used to free the chondral cartilage 2 to 3 mm along the inner edge of the open window. 5. Determine the best position and depth of the window shift Remove the shoulder pads and keep the patient in a position that is easy to sound. The different parts of the cartilage in the window are pressed inwardly at different pressures during the patient's utterance to determine the position of the cartilage within the optimal vocal window. At this time, a fiberoptic laryngoscope was inserted through the anterior nasal orifice to observe the condition inside the larynx. The optimal internal displacement position is not necessarily parallel to the thyroid cartilage, and some of the anterior portion is moved deeper, and some of the posterior portion is moved deeper, and a silicone sheet implant is prepared according to the internal displacement. 6. Window fixing The implant is made of a silicone block or a cartilage block and embedded in the window to move the vocal cord on the side of the operation. The silica gel block has the advantages that the material is easy to obtain and convenient to manufacture, so it is often used. The shape of the silica gel block can be made into two kinds, one is a silica wedge and the other is a silicone plug, the former is easy to shift, and the latter is relatively stable. The suture stitching was fixed with a 4-0 nylon thread. 7. Close the incision After the vocalization was satisfactory, the incision was sutured layer by layer, antibiotics were used in the incision, and no drainage was performed, and the pressure was tightly bandaged.