Effectiveness of vocal fold medialization surgery on the swallowing function of patients with unilateral vocal fold paralysis

Takeyuki Kono; Shuta Tomisato; Hiroyuki Ozawa

doi:10.1002/lio2.1125

Effectiveness of vocal fold medialization surgery on the swallowing function of patients with unilateral vocal fold paralysis

Laryngoscope Investig Otolaryngol. 2023 Jul 28;8(4):1007-1013. doi: 10.1002/lio2.1125. eCollection 2023 Aug.

Authors

Takeyuki Kono¹, Shuta Tomisato¹, Hiroyuki Ozawa¹

Affiliation

¹ Department of Otolaryngology-Head and Neck Surgery Keio University School of Medicine Tokyo Japan.

Abstract

Objectives: Vocal fold medialization surgery is generally considered a phonosurgical procedure for improvement of vocal function in patients with glottic insufficiency. However, the literature describing this procedure for the management of dysphagia is limited. This study aims to assess the effects of medialization surgery on swallowing function in patients with unilateral vocal fold paralysis (UVFP).

Methods: We enrolled 32 patients with UVFP undergoing vocal fold medialization surgery (medialization laryngoplasty combined with arytenoid adduction [ML + AA], 12 cases; injection laryngoplasty [IL], 20 cases). We assessed the aerodynamic vocal function including maximum phonation time and mean flow rate to evaluate glottal closure status. The Hyodo score determined by flexible endoscopic evaluation and Functional Oral Intake Scale (FOIS) were evaluated pre- and postoperatively.

Results: Almost 60% of patients with UVFP had dysphagia, and one-third were at high risk for aspiration. Aerodynamic parameters effectively improved after IL and ML + AA. With regard to swallowing, both the FOIS and total Hyodo score were significantly improved postoperatively. We found a particularly significant improvement in pharyngeal clearance. However, patients with high vagal nerve paralysis and postoperative insufficient glottal closure showed poor swallowing benefits after the interventions. In patients with recurrent laryngeal nerve palsy, there were no significant differences in postoperative swallowing function between the ML + AA and IL groups.

Conclusion: Vocal fold medialization surgery was effective in improving swallowing function in most cases with UVFP, except for those with high vagal paralysis and insufficient postoperative glottal closure. Both IL and ML + AA showed an equivalent effect on swallowing improvement.

Level of evidence: 3b.

Keywords: arytenoid adduction; injection laryngoplasty; medialization laryngoplasty; swallowing function; unilateral vocal fold paralysis.