White line (the equator) corresponds to the location of true vocal fold in the interior surface of thyroid cartilage. The midpoint between lowermost point of superior thyroid notch (1) and inferior border of thyroid cartilage (2) at midline and draw posteriorly parallel to the inferior border of thyroid cartilage outline the true vocal fold location. X - point of the initial drilling site for Gore-Tex thyroplasty window. Arrow - inferior thyroid tubercle. 3 - superior cornu of thyroid cartilage, 4 - inferior cornu of thyroid cartilage, circle - cricothyroid joint.
Needle prick between superior thyroid notch (yellow arrow) and inferior border of thyroid cartilage at midline (green arrow) points to the location of vocal folds at anterior commissure internally. E - epiglottis, C - cricoid cartilage, T - trachea.
Needle seen exactly at the anterior commissure. Arrows - true vocal folds, E - epiglottis, C - cricoid cartilage.
This image shows the initial drilling point of the thyroid cartilage which is about 1 cm posterior from the midline and about 3-4 mm above the inferior border or the thyroid cartilate. Cutting drill bead size 2 being used and the window widened and deepened until it reaches the innner perichondrium.
Kerrison punch forceps can be use to refine the thyroplasty
window especially on the inner side of the thyroid cartilage.
Inset show the tip of the forceps at rest and on action.
The use of drill to make thyroplasty window. Thyroid cartilate being rotated
to contralateral side by using skin hook anchored at superior thyroid notch.
R - right, L - left, C - chin, interrupted line - midline
Thyroplasty window with an inferiorly-based perichondrial flap.
Gore-Tex strip insertion in layers internally with the amount adjusted accordingly
by asking the patient to phonate (global medial bulge at true cord level).
Fiberoptic laryngoscopy can be performed simultaneously for the assessment.