[Phonosurgical methods of treatment in unilateral vocal folds paralysis].

Glottal insufficiency (GI) is a cause of breathy voice that can profoundly affect quality of voice. Main causes are unilateral vocal fold paralysis or endoscopic cordectomy for the early treatment of laryngeal cancer of the glottis. The main strategy in surgical treatment is type I medialization thyroplasty according to Isshiki with the use of implants e.g. silastic, hydroxyapatite, titanium, Gore-Tex or Montgomery. Other procedures are arytenoid adduction, the injection laryngoplasty via thyrohyoid and cricothyroid approach and laryngeal reinnervation. To predict successful voice outcome and to prevent revision surgery, surgeon must choose appropriate size of the implant on the basis of subjective intraoperative visualization of the glottal closure during phonation in fibroptic laryngoscopy and by objective measurement of peroperative maximal phonation time (MPT) or direct peak subglottic pressure (DPSP) through a catheter inserted into the cricothyroid membrane. Majority of otolaryngologist recommend surgical treatment 12 months after the onset of unilateral vocal fold paralysis, before performing any permanent intervention, because some patients will have full or partial recovery of the recurrent laryngeal nerve (RLN) function and others will have adequate compensation from the intact side.