James L. Netterville, MD, Donald T. Weed, MD, John L. Howard Cheryl L. Rainey, MS
Prudence Childs, RN, Robert H. Ossoff, DMD, MD

From a total database of 290 patients who have undergone medialization laryngoplasty (ML) with silicone or arytenoid adduction (AA), 36 patients have been followed up after revision surgery. These revisions were performed between January 1990 and March 1996. At the time of revision surgery, 22 patients underwent ML with silicone with AA, 14 underwent ML with silicone only, and I underwent AA only after the removal of the old implant. Palatal adhesion was performed in 7. This report provides a critical analysis of the voice results in 18 of these patients in whom the original ML procedure was performed by physicians other than the authors and whose revisions consisted of replacement of a new silicone implant alone (11 patients) of revision of the silicone implant in conjunction with AA (7 patients). Palatal adhesion was performed in 4 patients in this latter group. The variety of initial ML techniques represented among these 18 patients made this the most challenging subset of patients for successful revision surgery. Voice assessments consisted of preoperative and postoperative measures of the mean airflow rate and the maximum phonation time in 12 of 18 patients, and perceptual analysis of the overall desirability of the voice in 14 of 18 patients. The overall voice results showed an improvement to near normal in all three categories. The maximum phonation time improved from 9.4 to 15.6 seconds, the mean airflow rate improved from 320 to 192 mL/s, and the voice score changed from 17.9 to 35. 1, on a scale from 0 (aphonic) to 50 (normal). By following the surgical technique used in nonrevision ML with silicone with or without AA, coupled with removal of tile old implants, cartilage islands, and surrounding fibrous tissue, we successfully revised these difficult cases, with postoperative values similar to those in our series of patients in whom we performed the initial ML. One of the primary stated advantages of ML with silicone over other phonosurgical procedures for the treatment of vocal fold paralysis is the ability to secondarily modify the procedure to further enhance the voice result. This report provides confirmation of this contention.