Thyroplasty type I without arytenoid adduction in patients with unilateral laryngeal nerve paralysis: The Montgomery implant versus the Gore-Tex implant

Objective - The current series was designed to compare the results achieved with the Montgomery and Gore-Tex implants in thyroplasty type I without arytenoid adduction in patients with unilateral laryngeal nerve paralysis. Material and Methods - An inception cohort of 57 French language speakers with unilateral laryngeal nerve paralysis were managed with thyroplasty type I using Gore-Tex ( Group GT; n = 24) or Montgomery ( Group M; n = 33) implants. The two groups had similar patient characteristics. Morbidity, phonatory results according to self assessment by the patient and selected speech and voice parameters ( fundamental frequency, jitter, shimmer, noise: harmonic ratio, phonation time, phrase grouping and speech rate) were analyzed 1 month postoperatively in both groups. Results - Dyspnea, as noted in three patients, was the only immediate complication. Late complications included persistent inflammation of the vocal cord after insertion of a Gore-Tex implant, endolaryngeal extrusion of the Gore-Tex implant and dislodgment of the Montgomery implant in one patient each. Postoperatively, all patients reported improvements in speech and voice. Secondary degradation of speech and voice was noted in one patient in each group. Comparison of selected speech and voice parameters at 1 month postoperatively showed (i) a statistically significant ( p< 0.01) decrease in the jitter, shimmer and noise: harmonic ratio values and (ii) a statistically significant (p< 0.01) increase in the speech rate values in Group M compared to Group GT patients. Also, a trend (0.05 < p< 0.1) was noted towards an increase in the phrase grouping values in Group M compared to Group GT patients. Conclusions - Although limitations exist in the interpretation of the reported data, our results suggest that in patients with unilateral laryngeal nerve paralysis managed with a thyroplasty type I technique without arytenoid adduction, the use of a Montgomery compared to a Gore-Tex implant does not influence the success of the procedure according to the patient's self evaluation or the morbidity but does lead to a significant improvement in the values of selected speech and voice parameters.