thyroplasty using Gor-Tex
Dr T Balasubramanian
cord paralysis is a rather common problem causing speech problems to
the patient. If the other cord doesn’t compensate adequately these
patients may have troublesome aspiration also. Aspiration happens to
be the most dreaded complication of vocal fold paralysis. Management
of these patients is possible only by performing Medialization
thyroplasty (Ishiki type I thyroplasty). Various graft materials have
been used in this procedure. Presently lot of interest has been
generated in Gor-Tex medicalization thyroplasty.
Gor-Tex is expanded
polytetrafluroethylene has obvious
advantages as an implant material in Medialization thyroplasty
1. It is malleable
2. Its position can easily be
adjusted within the thyroid cartilage window
3. Only a small
fenestration is necessary in the lamina of thyroid cartilage to
introduce this material
4. This procedure is reversible and has
very few complications
5. Creates less oedema when compared to
that of silastic and hence over correction is not possible
Resultant quality of voice is really good
McCullouch reported the first case of medialization thyroplasty using
Gor-Tex in May 1996.
Indications of Gor-Tex
1. Unilateral vocal fold
immobility due to paralysis, paresis, atrophy
2. Unilateral vocal
fold scarring / soft tissue loss
3. In select cases of Parkinson’s
disease with vocal fold atrophy
1. Previous history of irradiation
Malignant lesions involving larynx
3. Poor abduction of
contralateral vocal fold as this would cause impairment of
This procedure is ideally performed under
local infiltration anesthesia using 2% xylocaine mixed with 1 in
100,000 units’ adrenaline.
crease incision beginning at the mid portion of the thyroid cartilage
extending to the paralyzed side.
The strap muscles are
separated away from midline and held apart from the operating field
using umbilical tape.
A tracheal hook is used at the level
laryngeal prominence and pulled medially. This helps in mobilizing
the cartilage better.
The thyroid cartilage perichondrium is
incised in the midline and extended laterally towards the paralyzed
side. The thyroid lamina on the paralyzed side is skeletonized up to
the level of cricothyroid membrane. Strips of cricothyoid muscle that
come in the way are excised.
Dimensions of cartilage
Appropriate size of cartilage window
is about 5mm x 10mm.
The lower border of the window should be about 3mm above cricothyroid
membrane. This ensures that the lower strut of thyroid lamina doesn’t
fracture when window is being created. Anterior border of the window
is about 8mm posterior to midline. If thyroid cartilage is calcified
then fissure burr can be used to create the window.
perichondrium is elevated from the under surface of thyroid lamina
using scissors. The inner perichondrium incised posteriorly and
inferiorly. It is not incised anteriorly. Now the cricothyroid
membrane is incised in order to separate it from the lower border of
thyroid cartilage. A septal elevator is introduced through the
inferior margin of thyroid lamina and the paraglottic space is
compressed medially while the voice of the patient is assessed. If
the result is acceptable then 1 cm wide Gor-Tex strips dipped in
bacitracin solution is introduced via the inferior margin of thyroid
lamina and delivered via the window. The amount of Gor-Tex insertion
is dependent on the improvement of quality of voice.