Personal Data

Prof.Dr.dr. Widodo Ario Kentjono, ENT-H&N Sp.

February 6, 1950, Jember

General Practitioner,
Fac. of Medicine,
Airlangga Univ. 1976
ENT Specialist, 1982
Doctor (S3), 2001
Head of Oncology –
Head & Neck Surgery Div.,
ENT Dept. Fac. of Medicine
Airlangga University
Surabaya - Indonesia

Mulyosari Utara 44, Sbaya

Phone : +62-31-5938896
Mobile : +62-81-8304362
E-mail : w_ario_k@yahoo.com
Medialization Thyroplasty with Gore-Tex
(Experiences in Surabaya)

Widodo Ario Kentjono

ENT Department
Faculty of Medicine Airlangga University
Dr. Soetomo General Hospital
Surabaya - Indonesia
INTRODUCTION
The voice is our foremost means of interaction

Unilateral adductor vocal cord paralysis

 Results in dysphonia because of poor glottic closure during
phonation
 Is a relatively uncommon
 Etiology
unilateral adductor vocal cord paralysis

Shashidhar et al, 2004

 Management
Unilateral Adductor Vocal Cord Paralysis

 Vocal cord augmentation / medialization

 Teflon, fat, collagen, fascia, gel foam, calcium
hydroxyapatite gel, polydimethylsiloxane gel
 Laryngeal frame work surgery
the most common is thyroplasty type I
(surgical implantation of various materials)
 Arythenoid adduction
 Reinnervation
 Type I Thyroplasty

Location and size of the window (hole)

Laryngeal frame work surgery
Type I – IV Thyroplasty
 Medialization Thyroplasty
(Type I Thyroplasty)
 The term Thyroplasty was introduced by Isshiki in 1974

 Is the treatment of choice for most cases of glottic

insufficiency, especially ant. glottic gap

 Various of materials used for implants

eg. autologous cartilage, silastic, cartilage with silastic,
hand carved silastic (silicone), Montgomery silastic,
hydroxyapatite, titanium
 effective in repositioning the paralyzed fold for
improved voice and glottic competancy

 Excellent results
 Medialization Thyroplasty (2)

 Advantages:
- Permanent, but surgically reversible
- No need to remove implant if vocal
function returns
- Excellent at closing anterior gap

 Disadvantages:
- More invasive
- Poor closure of posterior glottic gap
Medialization Thyroplasty with Gore-Tex
First reported 1998

Gore-Tex soft tissue patch

W.L. Gore & Associates, Inc

Arizona
Medialization Thyroplasty with Gore-Tex
- McCulloch and Hoffman (1998)  first authors to
describe the technique and report the use of Gore-Tex
implant for medialization thyroplasty

- Gore-Tex (expanded of Polytetrafluoroethylene) sheet

biomaterial
 thin, soft (fascia like tissue), innert, malleable,
superior handling, minimal tissue reaction,
biocompatible

- Principles : undermining of perichondrium 4-5mm

posterior and inferior to window, and insertion Gore-Tex
sheet (6-7 mm) under endoscopic visualization with
patient awake

- Success rate approximately 90%

 OPERATION PROCEDURE
1. Skin incision

Location of skin marker and incision of the neck

 OPERATION PROCEDURE (2)
2. Create of thyroid cartilage window

Thyrotomy window drilled approximately

5mm x 10mm (or less) using a 2mm burr,
1cm posterior to midline and 3-5mm above
lower edge of thyroid cartilage
 OPERATION PROCEDURE (3)
3. Elevation of inner perichondrium (2-3mm)
around the thyroid window
 OPERATION PROCEDURE (4)
Cut Gore-Tex into long 3mm (6-7mm) wide sheet

-
Gore Tex soft tissue patch

Modification of Gore Tex spiral cut to

form 6-7 mm wide ribbon
 OPERATION PROCEDURE (5)
4. Insertion of Gore-Tex into the pocked

A. External perichondrial flap & Thyrotomy window

B & C. Insertion of Gore-Tex into the pocked
 CASE REPORTS
Case I
Mr. Ch, 44 years old, Police, Situbondo.
ENT OPD Dr. Soetomo Hospital 12/22/04:
• Persistence hoarsness 6 weeks (10 days after
traffic accident)
• FOL & Videostroboscopy : Unilateral adductor vocal
cord paralysis on the left side
Medialization Thyroplasty with Gore-Tex (01/11/05)
• Videostroboscopy 1 month after surgery : vocal
cord near to middle position, there was still a few
gap on the anterior rima glottis, ventricularis plica
was hyperemis and looked to be bump
• Voice quality increase ± 60%
 Stroboscopy
(case 1)

Before surgery 1 month after surgery

 Sound analysis
(case 1)

Before surgery 1 month after surgery

 Case 2
Mrs. S, 37 years old, merchant, Surabaya.
ENT OPD Dr. Soetomo Hospital 12/24/04:
• Persistence hoarsness after thyroid surgery
(06/28/04)
• FOL & Stroboscopy : Unilateral adductor vocal
cord paralysis on the right side
Medialization Thyroplasty with Gore-Tex (01/11/05)
• Videostroboscopy 1 month after surgery : vocal
cord to middle position with a few gap on the
anterior rima glottis
• Voice quality increase ± 90%
 Stroboscopy
(case 2)

Before surgery 1 month after surgery

 Sound analysis
(case 2)

Before surgery 1 month after surgery

 Case 3
Mrs. M, 35 years old, house-wife, Surabaya.
ENT Dept. Dr.Ramelan Navy Hospital 01/25/05:
• Persistence hoarsness 8 months
• FOL & Stroboscopy : Unilateral adductor vocal
cord paralysis on the left side

Medialization Thyroplasty with Gore-Tex (05/09/05)

• Videostroboscopy 1 month after surgery : vocal
cord to middle position with a few gap
• Voice quality increase ± 70%
 Stroboscopy
(case 3)

Before surgery 1 month after surgery

 Sound analysis
(case 3)

Before surgery 1 month after surgery

Conclusions

- Phonosurgery is designed to alter phonation

- Type I Thyroplasty is recommended for
unilateral adductor vocal cord paralysis
- Anterior and posterior glottic gap must be
addressed
- Medialization Thyroplasty with Gore-Tex
implantations is simple, and minimally
invasive procedure.
- Voice improvement is moderate to excellent
(60% - 90%)
- The complication rate is low