Bilateral medialization laryngoplasty

Objectives: To present indications, techniques, and results of bilateral medialization laryngoplasty (BML). Study Design: Retrospective review of 39 consecutive patients who had BML for correction of glottal insufficiency attributable to presbylaryngis (n = 16), bilateral vocal fold paresis (n = 13), unilateral paralysis with contralateral bowing (n = 4), and other miscellaneous neurologic diseases (n = 6). Methods: Complete preoperative and postoperative clinical and acoustical data were analyzed for 74% (29/39) of the subjects. All 39 subjects completed a patient survey to assess their long-term outcomes. Results: Overall, 90% (35/39) of the patients who had BML experienced significant improvement in voice and swallowing function. Subsequently, 36% (14/39) of the patients underwent adjunctive lipoinjection for closure of small residual glottal gaps (vocal 'fine-tuning'). Of the BML patients (with or without lipoinjection) who had complete preoperative and postoperative voice data, 83% (24/29) had complete glottal closure after surgery, resulting in normal or near-normal voices. Eighty-five percent (33/39) of the patients responded that they 'would have surgery again.' Of the six patients who said that they would not have surgery again, three had good results and one had progressive neurologic disease. The mean duration of follow-up was 17 months. Conclusions: BML is an effective rehabilitative surgical treatment for symptomatic vocal fold bowing. In addition, lipoinjection is useful as an adjunct to BML to enhance the voice outcome in selected cases.