Safety and Adverse Events of Medialization Thyroplasty: A Systematic Review

• Published in: The Laryngoscope Vol. 134; no. 5; pp. 1994 - 2004
• Main Authors: Valley, Zachary A., Karp, Avrohom, Garber, David
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-05-2024; Wiley Subscription Services, Inc
• Subjects: medialization thyroplasty; Systematic review; Transplants & implants; type I medialization laryngoplasty; unilateral vocal fold paralysis; type I medialization laryngoplasty; unilateral vocal fold paralysis; medialization thyroplasty
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.31141

Introduction
Unilateral vocal fold paralysis or paresis (UVFP) is a condition that causes significant morbidity due to dysphonia, dysphagia, and aspiration. Type I medialization thyroplasty (MT) is the current mainstay surgical treatment for UVFP. Though widely considered a safe procedure, concerns exist over possible airway complications which can lead to overnight observation. Herein, we report a systematic review of the safety and adverse events of MT to aid in determining the safety of same‐day discharge.
Data Sources
PubMed and Embase databases.
Review Methods
Our search identified studies investigating complications associated with MT. Articles were selected if published between January 1, 1989 and March 15, 2023. s were screened, and data were extracted from included studies. Only Type I MT procedures were included; case reports were excluded. Participant characteristics, intervention details, results, and adverse events were extracted.
Results
The database query identified 751 s, of which 46 studies met eligibility criteria. A total of 2426 patients underwent MT. The most common implant was Silastic (n = 898, 37.0%) followed by Gore‐Tex (n = 664, 27.4%). There were 254 (10.5%) total complications reported; 110 (4.5%) were considered major. The most common complication was nonobstructive hematoma (n = 59, 2.4%) followed by hemorrhage (n = 36, 1.5%). Implant extrusion (n = 24, 0.99%) or displacement (n = 15, 0.62%) occurred mostly in Silastic and Gore‐Tex implants. Same‐day discharge occurred with 429 patients and was not associated with adverse events.
Conclusions
UVFP can be reliably improved by MT with a low risk of complications. Outpatient MT is a promising treatment with a favorable safety profile. Laryngoscope, 134:1994–2004, 2024
Type I medialization thyroplasty (MT) continues to be the gold standard treatment for unilateral vocal fold paralysis and is generally considered a safe procedure. In this systematic review, we analyzed 46 primary research articles with a total of 2426 patients who underwent MT and found that the surgery continues to be a safe, well‐tolerated procedure. The literature also suggests that same‐day discharge following MT resulted in no significant increase in complication rate.