Technical refinements to the minithyrotomy procedure.

Abstract

OBJECTIVES/HYPOTHESIS: Although the minithyrotomy (MT) procedure was introduced in 1999, it has not been widely used for voice restoration. Its limited dissemination is due in part to lack of appropriate implants and in part due to technical challenges. The 2011 introduction of the composite thyroid ala perichondrium flap (CTAP) into a vocal fold through an MT was designed to supply an appropriate implanted tissue. However, technical difficulties persisted. Noted impediments have included limited surgical access, potential CTAP pedicle constriction during healing, lack of specialized surgical instrumentation, and potential retraction or extrusion of CTAPs. This study was performed to address these technical challenges with or without the use of CTAP reconstruction. STUDY DESIGN: Experimental. Cadaveric and in vivo canine model. METHODS: Experimentation on canine cadaveric larynges yielded MT and CTAP alterations, instrument creation, and implant affixation procedures. These refinements were applied in vivo using canine subjects. Two weeks post-CTAP repair, subjects were humanely euthanized, followed by laryngeal harvest and histologic analysis of the vocal folds. RESULTS: Refinements to CTAP modification, MT, instrumentation, and CTAP affixation are successful in vivo, just as in preliminary cadaveric trials. CONCLUSIONS: The proposed refinements were designed to improve the outcomes achieved via a CTAP specifically but have utility for any MT approach. Continued improvements to specialized instrumentation are necessary. Enhanced affixation of a CTAP, with improved accuracy and easier deployment are also essential. Further refinements should allow more reliable implementation of the MT by a growing number of laryngeal surgeons.