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A new paramedian approach to arytenoid adduction and strap muscle transposition for vocal fold medialization.
Laryngoscope. 2002 Feb; 112(2):342-50.L

Abstract

OBJECTIVE

To develop a prosthesis-free medialization laryngoplasty for the treatment of glottal incompetence.

STUDY DESIGN

Twenty-two consecutive patients with glottal incompetence underwent vocal fold medialization using a new paramedian approach to arytenoid adduction and/or strap muscle transposition.

METHODS

Under local anesthesia, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. After dividing the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally, the inner perichondrium was opened, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 or 3-0 Prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium and the thyroid cartilages sutured back into place. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and maximal phonation time, as well as assessments of voice quality.

RESULTS

Vocal improvement was obtained in 95% (21 of 22) of patients. There was a significant improvement (P <.05) in all parameters except shimmer. No major complications were noted in any patient, except for dyspnea in one patient resulting from arytenoid overrotation.

CONCLUSION

The results suggest that a paramedian approach to arytenoid adduction combined with strap muscle transposition is a safe and effective method for treating glottal incompetence, particularly in patients with unilateral paralytic dysphonia.

Authors+Show Affiliations

Department of Otolaryngology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung, Taiwan. usgniy@adm.cgmh.org.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11889395

Citation

Su, Chih-Ying, et al. "A New Paramedian Approach to Arytenoid Adduction and Strap Muscle Transposition for Vocal Fold Medialization." The Laryngoscope, vol. 112, no. 2, 2002, pp. 342-50.
Su CY, Lui CC, Lin HC, et al. A new paramedian approach to arytenoid adduction and strap muscle transposition for vocal fold medialization. Laryngoscope. 2002;112(2):342-50.
Su, C. Y., Lui, C. C., Lin, H. C., Chiu, J. F., & Cheng, C. A. (2002). A new paramedian approach to arytenoid adduction and strap muscle transposition for vocal fold medialization. The Laryngoscope, 112(2), 342-50.
Su CY, et al. A New Paramedian Approach to Arytenoid Adduction and Strap Muscle Transposition for Vocal Fold Medialization. Laryngoscope. 2002;112(2):342-50. PubMed PMID: 11889395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A new paramedian approach to arytenoid adduction and strap muscle transposition for vocal fold medialization. AU - Su,Chih-Ying, AU - Lui,Chun-Chung, AU - Lin,Hsin-Ching, AU - Chiu,Jeng-Fen, AU - Cheng,Chu-An, PY - 2002/3/13/pubmed PY - 2002/3/28/medline PY - 2002/3/13/entrez SP - 342 EP - 50 JF - The Laryngoscope JO - Laryngoscope VL - 112 IS - 2 N2 - OBJECTIVE: To develop a prosthesis-free medialization laryngoplasty for the treatment of glottal incompetence. STUDY DESIGN: Twenty-two consecutive patients with glottal incompetence underwent vocal fold medialization using a new paramedian approach to arytenoid adduction and/or strap muscle transposition. METHODS: Under local anesthesia, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. After dividing the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally, the inner perichondrium was opened, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 or 3-0 Prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium and the thyroid cartilages sutured back into place. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and maximal phonation time, as well as assessments of voice quality. RESULTS: Vocal improvement was obtained in 95% (21 of 22) of patients. There was a significant improvement (P <.05) in all parameters except shimmer. No major complications were noted in any patient, except for dyspnea in one patient resulting from arytenoid overrotation. CONCLUSION: The results suggest that a paramedian approach to arytenoid adduction combined with strap muscle transposition is a safe and effective method for treating glottal incompetence, particularly in patients with unilateral paralytic dysphonia. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/11889395/A_new_paramedian_approach_to_arytenoid_adduction_and_strap_muscle_transposition_for_vocal_fold_medialization_ L2 - https://doi.org/10.1097/00005537-200202000-00026 DB - PRIME DP - Unbound Medicine ER -