From the Guidelines
The worst prosthesis for thyroplasty is Gore-Tex (expanded polytetrafluoroethylene) due to its association with foreign body granulomas that can result in voice deterioration and airway compromise, as reported in the most recent clinical practice guideline update 1.
Thyroplasty Prosthesis Options
The options for thyroplasty prostheses include:
- Autologous materials, such as cartilage, which offer excellent biocompatibility with minimal rejection risk
- Silastic (medical-grade silicone), which is considered the gold standard material for thyroplasty due to its appropriate stiffness, flexibility, and biocompatibility
- Ceramic materials, which are generally not suitable for thyroplasty procedures due to their rigidity and poor biocompatibility with vocal fold tissues
- Gore-Tex (expanded polytetrafluoroethylene), which is not recommended due to its association with foreign body granulomas
Rationale for Recommendation
The use of Gore-Tex (expanded polytetrafluoroethylene) as a permanent injectable implant is not recommended due to its potential to cause foreign body granulomas, leading to voice deterioration and airway compromise, as stated in the clinical practice guideline update 1 and also mentioned in an earlier study 1. In contrast, Silastic (medical-grade silicone) and autologous materials have been shown to provide good outcomes in thyroplasty procedures, with minimal complications. Ceramic materials are not commonly used in thyroplasty due to their rigidity and poor biocompatibility.
Key Considerations
When selecting a thyroplasty prosthesis, it is essential to consider the material's biocompatibility, flexibility, and potential for complications. The ideal thyroplasty implant should balance appropriate stiffness with flexibility to allow natural vocal fold vibration while providing the necessary medialization of the vocal fold for proper phonation. According to the most recent clinical practice guideline update 1, the use of Gore-Tex (expanded polytetrafluoroethylene) is not recommended, making it the worst prosthesis option for thyroplasty.
From the Research
Types of Thyroplasty Prostheses
- Autologous: considered a viable option for thyroplasty, particularly in complex or revision procedures 2
- Silastic (silicone): commonly used, but may be accompanied by risks of carcinogenicity, foreign body reaction, and induction of collagen disease 3, 4, 5, 6
- Ceramic: proposed as a safe substitute for silicone, with satisfactory results in a limited number of cases 3
- Gore-Tex (expanded polytetrafluoroethylene): provides comparable results to Silastic, but with limited data availability and publication bias 5
Comparison of Outcomes
- Silastic and Gore-Tex implants have been compared in a systematic review and meta-analysis, showing comparable results in terms of maximum phonation time and voice handicap index scores 5
- Bilateral medialization thyroplasty using silastic or hydroxyapatite implants has been shown to improve vocal quality in patients with presbylaryngis 6