Reconstruction of defects in the paraglottic space from polytetrafluoroethylene granuloma and other thyroplasty implants

Implants used to medialize the vocal fold can at times need to be removed for a variety of reasons. Polytetrafluoroethylene (Teflon ^®), which was commonly used to medialize paralyzed vocal folds before the turn of the 21st century, has been found to cause granuloma formation that can continue to grow and expand years after injection. As Teflon ^® granulomas form, they often cause a convexity of the medialized vocal fold and a resultant strained and hoarse voice. Treatment of the dysphonia caused by Teflon ^® granulomas requires complete excision of the granuloma, which often results in a large defect in the paraglottic space and a large glottic gap. The voice is then rehabilitated by filling the defect in the paraglottic space while simultaneously medializing the paralyzed vocal fold. My technique for doing so involves a one-stage procedure in which the granuloma is removed via a lateral thyrotomy and the paraglottic space defect is reconstructed with a pedicled sternohyoid muscle flap that is secured with titanium miniplates. This technique for reconstruction can also be used for large paraglottic space defects created from Silastic ^®, hydroxyapatite, and Gore-tex ^® thyroplasty implants that need to be removed because of implant migration, infection, or extrusion.