• Thyroplasty is a phonosurgical technique designed to improve the voice by altering the thyroid cartilage of the larynx (the voice box), which houses the vocal cords in order to change the position or the length of the vocal cords.
  • Isshiki divided thyroplasty procedures into 4 categories to produce functional alteration of vocal cords 
  • Medial displacement of vocal cord (done by injection of gel foam/Teflon paste).
  • Indications:
  • Unilateral vocal cord paralysis 
  • In a case of unilateral vocal cord palsy
  • : Vocal cord of the affected side will lie in the cadavaric position.The healthy cord is unable to approximate the paralysed side.
  • This results in hoarseness of voice and aspiration occurs through the glottis.
  • Thyroplasty type I(Injection of Teflon paste, lateral to the paralysed cord) is helpful.
  • Symptomatic glottic insufficiency (dysphonia, aspiration) which leads to incomplete glottic closure which in turn results in failure to produce proper sound.
  • Age-related vocal fold atrophy leading to glottic insufficiency.
  • Lateral displacement of cord (done to improve the airway).
  • Adductor spasmodic dysphonia :
  • Condition in which there is distortion of the voice due to excessively tight closure of the glottis on phonation. 
  • Generally, lateralization thyroplasty is intended to prevent this tight closure of the glottis at the terminal stage of phonation by lateralizing the position of the vocal cord. TYPE 3
Lengthening (relax) the cord, to lower the pitch .
Relaxation of the vocal cords is done by antero-posterior shortening of the thyroid ala.
  • It is most commonly indicated in males with high-pitch voices and those who are resistant to voice therapy(Puberphonia).
  • In people with spasmodic dysphonia.
  • In people who have stiff vocal folds with high-pitched breathy voices.
Shortening (tightening) the cord, to elevate the pitch.
  • It is done in people with bow-shaped vocal folds.
  • Androphonia (condition characterized by low vocal pitch).
Exam Question
  • In thyroplasty type 2, vocal cord is lateralized.
  • Vocal cord medialization is the indication of type-I thyroplasty.
  • Type III Thyroplasty is the surgical treatment of Puberphonia.
  • U/L vocal cord palsy treatment includes Isshiki type I thyroplasty

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