1.Overstay more than package days, 2. Any other Specialty Consultations, 3. Special Equipment, 4. Additional Procedure/Surgery. 5. Blood Components.
What is Thyroplasty?
Thyroplasty is a surgical procedure that is performed for vocal cord paralysis. It is used to improve a patient’s voice and ability to cough. The procedure alters the thyroid cartilage of the larynx (the voice box) which houses the vocal cords, in order to change the length or position of the cords.
Causes of Vocal cord Paralysis
When the vocal cords are paralysed there is a weakness in at least one of the cords that causes hoarseness and even slight choking.
The short procedure is performed under local anaesthesia and using intravenous sedation so that the surgeon can check the patient’s voice throughout the process. A small hole is made in the neck area of the voice box and the thyroid cartilage is removed to provide access to the vocal cords. An implant is positioned near the vocal cord, which pushes the vocal cord closer to the middle section. Once in place, a fibre optic scope is inserted, which allows the surgeon to view the larynx and check that the implant is in the correct position. The patient may then be asked to speak during the laryngoscopy to enable the surgeon to check the movement of the vocal cords.
Types of procedures
Currently, there are four types of implant procedures which are used to perform thyroplasty.
Montgomery Thyroplasty Implant system
This system consists of different sizes and shapes of shims made of silastic. It has the most proven success rate and the duration of the procedure is slow in comparison to other implant system. The other advantage is that it does not require suturing. It has reduced incidence of trauma. In this type of implant system, the thyroid cartilage is pushed towards the medial side using the silastic implant.
VoCoM system (vocal fold medialization)
This system consists of different sizes and shapes of implants made from hydroxyapatite (a naturally occurring mineral form of calcium apatite). It helps in achieving accurate vocal fold medialization. This procedure is technically reversible. But it should be used in candidates of permanent implantation due to its biocompatible clinical use lasting for nearly a decade.
This system generally consists of two sizes of implants made out of pure titanium. It has a lot of advantages and the main one is that it reduces the operative time. Titanium is safer than other implants. It has great biocompatibility. The implants are available in only two variants and they are designed in such a way that they ensure optimal fixation. The implant can be easily made as the titanium sheet is easy to shape.
Gore-Tex Implant system
In this type of implant system, the implant is made of homopolymer of polytetrafluoroethylene in form of minute beads arranged in a fine fiber mesh. It is malleable and can be inserted through a small window.
Your throat may take 6-8 weeks to heal after surgery, so over this time you should treat your voice with care. Avoid smoking and drinking alcohol and if you have been prescribed reflux medication make sure you continue to take it regularly.
Risks Involved in the Thyroplasty
• Poor voice quality (hoarseness) – worsening of the voice is rare
• Difficulty breathing – swelling after surgery
• Implant migration – there have been reports of migration into the airway or neck
• Bleeding – this is rare but typically stops on its own
• Infection – this is treated with antibiotics or surgery in rare cases
• Pain in the neck – which is common after surgery
The operation itself will probably be done as a day case, so you should be able to go home on the same day. The vocal cords may take 6-8 weeks to fully heal after microlaryngoscopy, so over this time, you should treat your voice with care.
Physician will prescribe three to seven days of voice rest after surgery. This means absolutely no talking, throat clearing, whispering, or coughing (if you can avoid it). Any noise that you make can be damaging and may make it difficult for the vocal cords to heal properly.
Treatment of vocal cord paralysis depends on the cause, the severity of symptoms and the time from the onset of symptoms. Treatment may include voice therapy, bulk injections, surgery or a combination of treatments. In some instances, you may get better without surgical treatment.
In most cases of vocal cord paralysis, only one vocal cord is paralyzed. Paralysis of both of your vocal cords is a rare but serious condition. This can cause vocal difficulties and significant problems with breathing and swallowing.
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