Effectiveness of laryngeal reinnervation compared to medialization thyroplasty in the treatment of unilateral vocal fold paralysis: A systematic review and network meta-analysis.

Introduction: Unilateral vocal fold paralysis (ULVP) is characterized by the complete immobility of a single vocal fold which can cause significant health challenges, including voice impairment, difficulty swallowing, and a high risk of aspiration due to glottic incompetency. The aim of this study is to systematically review the effectiveness of laryngeal reinnervation (LR) and medialization thyroplasty (MT) in the treatment of ULVP. Materials and Methods: Medline, PubMed, Cochrane Library, OVID, Scopus, Springer Nature Journals, ScienceDirect, and Directory of Open Access Journals databases were searched. Restriction to non-English studies were applied. Studies were excluded if subjects had previous treatment for ULVP, if they had co-existing neuromuscular disease affecting the larynx, and if they had significant non-laryngeal speech abnormalities. Results: Fifteen articles were reviewed, all conducted between 2003 and 2023. Among the 864 participants included, 48 underwent LR, 348 underwent MT, and the remaining 432 were in the comparison group, which involved injection laryngoplasty (IL), voice therapy (VT), placebo, and medialization with arytenoid adduction. Meta-analyses compared LR to MT and MT to alternative treatments, revealing a preference for MT. The comparison between LR and MT in the network meta-analysis yielded a mean difference of 0.33 (95% CI: -11.79, 12.6) favoring the MT group, ranking using SUCRA values highlighted that MT is the best treatment modality followed by LR. Discussion: The results of the network meta-analysis and the subgroup meta-analysis showed that MT is better than alternative treatments that were included in this study. Moreover, management modalities should be individualized to each patient as many factors are important and may affect the final outcomes. Conclusions: While the network meta-analysis indicates that MT may be more effective than alternative treatments for managing ULVP, the results should be interpreted with caution due to potential confounding factors. One notable limitation is the small sample size in the LR group. Despite these limitations, the findings contribute to the existing literature and can help guide future research on optimal interventions for the treatment of ULVP.