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Prof. Pecorari G, MD 1 ; Gallonne GO, MD 1 ; Raimondo L, MD 1 ; Nadalin J, MD 1 , Sensini M, MD 1 ; Riva G, MD 1 , Prof. Giordano C 1 , MD 2 1 st ENT Division, University of Turin - Italy University of Turin “S. Giovanni Battista” Hospital MONTGOMERY THYROPLASTY AFTER CORDECTOMY: VOCAL OUTCOMES ABSTRACT Objective Providing good vocal outcomes to vocal fold cancer patients, after open or endoscopic cordectomy, is a hot topic; several authors compared different phono-surgical techniques focusing their attention on feasibility. Aim of our study was to evaluate objective and subjective vocal outcomes after Montgomery Thyroplasty. Methods During 2011, at the I ENT Division of Turin University, 8 patients underwent Montogomery thyroplasty followed by 6 months of speech rehabilitation. Inclusion criteria were: glottic incompetence and 3 yrs of follow up after cordectomy. Voice evaluation was performed using videolaryngostroboscopy, Multidimensional Voice Program (MDVP) and VHI-10. Results After six months from the surgical procedure, the laryngostroboscopy showed an improved glottic closure during phonation even if irregular and incomplete. Preoperative and postoperative MDVP parameters were compared by means of T Student Test, observing a statistically significant improvement of all parameters (p<0.05). The most relevant improvements were observed in: Average Fundamental Frequency (192Hz vs 161.7Hz), Absolute Jitter (645µs vs 57µs) , Shimmer (2.1dB vs 0.82dB), Amplitude Perturbation Quotient (17.6 % vs 6.1%) and Medium Phonation Time (3,5s vs 5,12s). VHI-10 mean score improved from 33.4 to 25.7 (p<0.05). Conclusion Our data suggest that Montgomery Thyroplasty, associated to speech rehabilitation, is an efficient and well tolerated rehabilitative approach in order to improve vocal outcomes of vocal fold cancer patients treated with open or endoscopic laser cordectomies. a. Preparation and Drape REFERENCES 1. Young, MD et al; Analysis of Laryngeal Framework Surgery: 10-Year Follow-up to a National Survey; Laryngoscope, 120:1602–1608, 2010 2. Dursun G, et al Long term results of different treatment modalities for glottis insufficiency. Am J Otolaryngol 2008;29:7–12. 3.Villaret AB, et al. Phonosurgery after endoscopic cordectomies.II. Delayed medialization techniques for major glottic incompetence after total and extended resections. Eur Arch Otorhinolaryngol 2007;264:1185–1190. 4.Peretti G, et al. Vocal outcome after endoscopic cordectomies for Tisand T1 glottic carcinomas. Ann Otol Rhinol Laryngol 2003;112:174–179. 5.Zeitels SM, et al Voice and treatment outcome from phonosurgical management of early glottic cancer. Ann Otol Rhinol Laryngol Suppl 2002;190:3–20. 6.Remacle M, et al. Medialization framework surgery for voice improvement after endoscopic cordectomy. Eur Arch Otorhinolaryngol 2001;258:267–271. 7.Remacle M, et al. Endoscopic cordectomy. A proposal for a classification by the Working Committee, European Laryngological Society. Eur Arch Otorhinolaryngol 2000;257:227–231. 8.Delsupehe KG, et al.Voice quality after narrow-margin laser cordectomy compared with laryngeal irradiation. Otolaryngol Head Neck Surg 1999121:528–533 9.Remacle M, et al. CO2 laser in the diagnosis and treatment of early cancer of the vocal fold. Eur Arch Otorhinolaryngol 1997;254:169–176 10.Rydell R, et al. Voice evaluation before and after laser excision vs. radiotherapy of T1A glottis carcinoma. Acta Otolaryngol 1995 115:560–565 11.Cragle SP, et al (1993) Laser cordectomy or radiotherapy: cure rates, communication, and cost. Otolaryngol Head Neck Surg 108:648–654 12.Casiano RR, et al (1991) Laser cordectomy for T1 glottic carcinoma: a 10-year experience and videostroboscopic findings. Otolaryngol Head Neck Surg 104:831–8 CONTACT: Luca Raimondo, MD Physiopathology Dept - University of Turin - Via Genova, 3 - 10126 Turin, Italy E-mail: [email protected] MONTGOMERY THYROPLASTY TECHNIQUE b. Expose Thyroid Cartilage c. Locate Key Point d. Apply outline instrument on the key point e. Window Outline e. Create Window f. Remove Cartilage h. Confirm Window Size i. Apply Measuring Device l. Insert Implant with Implant Insert m. Implant in Place PRE POST
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