Approach and technique by Dr. Enrique Zapater
In otolaryngology practice, medialization thyroplasty is an essential technique used to address symptoms associated with unilateral vocal cord paralysis. In this live surgery of the App SURGSCHOOL We will analyze the medialization thyroplasty procedure, performed by the Dr. Enrique Zapater, Head of the Otolaryngology Service at the General University Hospital of Valencia.
Anesthesiologist-Surgeon Cooperation:
Close collaboration between the anesthesiologist and surgeon is crucial during medialization thyroplasty. General anesthesia is used with ventilation through a laryngeal mask, which allows direct visualization of the glottis without the need for a fibrolaryngoscope. Muscle relaxation with roncuronium is used to reduce the risk of laryngospasm and facilitate ventilation during the procedure.
Surgical technique:
The procedure begins with the detachment of the perichondrium to facilitate the location of the laryngeal tubercle and allow coverage of the prosthesis at the end of the procedure. Using specific surgical instruments, a theoretical window is marked in the region indicated by Montgomery. Instead of resecting the window, lines are milled to insert steel gauges to monitor changes in the glottis.
Individualization of the Procedure:
Endoscopic monitoring allows individualization of the cartilaginous window, avoiding inappropriate insertions into the ventricle or subglottis. Adjustments are made in the vertical and horizontal axes as necessary to ensure optimal placement of the prosthesis. During the procedure, the anesthesiologist monitors the peak pressure to ensure adequate ventilation.
Results and Monitoring:
After milling the window in the determined location, the appropriate size of the prosthesis is chosen using specialized gauges. Rotation of the arytenoid and medialization of the vocal process are observed as indicators of success. The cartilaginous window is adjusted according to endoscopic monitoring, ensuring precise and effective medialization.
