Surgical treatment of spasmodic dysphonia

Abstract

Although botulinum toxin therapy is accepted worldwide as the treatment of choice for control of spasmodic dysphonia, the therapeutic usage of botulinum toxin is strictly limited to patients with blepharospasm or wryneck in Japan. It is problematic to treat spasmodic dysphonia, a relatively rare condition in Japan, without the use of botulinum toxin. Several surgical interventions were performed such as a partial removal of thyroarytenoid muscle under direct laryngoscope. The short-term outcomes were reported to be good, however, long-term results remain controversial since these procedures are categorized as destructive.
Isshiki et al reported that type II thyroplasty was effective in treating patients with spasmodic dysphonia. In our hospital this procedure was modified and applied to 7 patients with spastic dysphonia. A horizontal skin incision was made at the mid-portion of thyroid cartilage under local anesthesia and the bilateral thyroid ala was separated at the midline keeping the anterior commissure intact. The anterior edges of the thyroid ala were retracted laterally until the spasticity of the patient's voice was relieved. Once the adequate glottal gap was determined, silicone block was inserted between the bilateral thyroid ala and then fixed in place by nylon thread. All patients noticed an improvement in their speech function during the surgery and were satisfied with their postoperative outcomes. This approach has the advantages of being a simple and reversible procedure, being open to the application of additional available techniques, and capable of revision surgery.