Statico-Dynamic Island Laryngoplasty with Crossed Musculoplasty and Transmitted Dynamism (for Vocal Cord Palsy): a New Technique

Abstract

Only static medialisation of the paralysed vocal cord is most commonly performed today for vocal cord palsy which does not offer very good voice post-operatively. Colledge and Balance’s (1927) operation of anastomosis of the phrenic nerve to the recurrent laryngeal nerve for laryngeal palsy or Tuckers (1976) nerve muscle pedicle technique has not offered significant reanimation of the paralysed muscles of the vocal cord. Moreover, it is virtually impossible to offer dynamism to the paralysed muscles; but dynamism can conveniently be transmitted to the paralysed vocal cord by appropriate muscle transplantation as has been done in palatopharyngoplasty for rhinolalia aperta (Ghosh 1983, 1986). Isshiki’s laryngoplasty operations (1977) also offer only static correction. In view of the above short comings, the present statico-dynamic operation was conceptualised. A new technique of medialisation of the paralysed vocal cord statico-dynamically for improvement of voice is described here. In one operation, such as this, both arytenoid adduction and vocal cord adduction are expected to be achieved. A rectangular island of lamina of the thyroid cartilage, attached to the inner perichondrium, on the paralysed side, is created by drilling an endless canal on the lateral aspect of the thyroid lamina to the level of the inner perichondrium. The mobile cartilage island along with the vocal cord and the arytenoid is fixed in a medialised position. Dynamism is quintessential for normal vocal cord function. For this, superiorly and inferiorly based superior and inferior bellies of the omohyoideus are passed over the island of cartilage crossing each other, forming the ‘crossed musculoplasty’. By their contractions further adduction of the island along with its attached vocal cord is brought about, thus further improving the quality of voice.