Introduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the... Show moreIntroduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy.Material and Method. Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS's instructions for use (the "expected window" (EW)), and comparing it to the actually realized fenestration (the "realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (), and (d) the orientation of RW's center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed.Results. The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16 [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males.Conclusions. Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients. Show less
This thesis provides a 360° assessment of one thyroplasty implant called the Montgomery Thyroplasty Implant System (MTIS).The author made an effort to use alternative and innovative research... Show moreThis thesis provides a 360° assessment of one thyroplasty implant called the Montgomery Thyroplasty Implant System (MTIS).The author made an effort to use alternative and innovative research techniques. The originality lies in the choice of the Pareto technique as literature review, in the technique of the e-mail survey as to the use of voice indicators by practitioner, in a proof-of-concept study of an innovative (perhaps even disruptive) endoscopic measuring technique, and finally in the development of a new concept, the α -ratio with the use of virtual CT scan reconstruction to study the interactions between thyroid cartilage morphology and post-operative voice results.Thesis results can be summarized as follows:Most commonly used Voice Outcome Indicators (VOIs) to determine the effectiveness of surgical Unilateral Vocal Fold Palsy (UVFP) treatment are: Maximum Phonation Time and Voice Handicap Index. Mean Airflow is a VOI deserving further investigations.MTIS is a simple technique, offering permanent results with the possibility of treating posterior glottal gaps in most UVFP configurations.MTIS provides excellent results for male individuals. Female patients have a lower benefit after MTIS. The depth of the implant, as well as cartilage fenestration location, are factors influencing this gender discrepancy Show less
