Glottic Closing Force: Impact of Thyroplasty on Vocal Cord Paralysis in a Pig Model

Abstract

Reflex glottic closure is an essential component of a normal swallow. A lesion of the unilateral recurrent laryngeal nerve weakens this reflex response, affecting the essential protective functions of the larynx and potentially resulting in aspiration pneumonia, sepsis, or death. Thyroplasty has been advocated to reduce glottic incompetence due to unilateral vocal cord paralysis (UVCP). Although medialization thyroplasty has traditionally been evaluated in terms of its phonatory effect, its role in improving protective glottic closure has never been studied. The present study was designed to evaluate the effect of UVCP and thyroplasty type I on the glottic closing force (GCF). Five male Yorkshire pigs weighing approximately 40 kg were used in this study. Both internal superior laryngeal nerves were simultaneously stimulated with bipolar platinum-iridium electrodes, and the force of evoked glottic closure was measured with a pressure transducer positioned between the vocal cords. Initial pressure readings (GCF) obtained with bilaterally intact recurrent laryngeal nerves served as a control. The GCF was then measured after the right recurrent laryngeal nerve was sectioned to simulate the conditions of UVCP. Finally, thyroplasty type I was performed on the affected side, and the GCF was measured again to evaluate its quantitative effect on reflex glottic closure. The mean GCF was reduced by UVCP to approximately 22.5% (49.71 mm Hg) of the control GCF (220.25 mm Hg). Thyroplasty enhanced the GCF to 57.7% (127.08 mm Hg) of the control GCF. These measures underscore the profound effect that UVCP exerts on the GCF and the limitations of vocal cord medialization in fully restoring it.