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Functional significance of arytenoid adduction with the suture attaching to cricoid cartilage versus to thyroid cartilage for unilateral paralytic dysphonia.
Laryngoscope. 2005 Oct; 115(10):1752-9.L

Abstract

OBJECTIVE

In the treatment of unilateral paralytic dysphonia, traditional arytenoid adduction is designed to place suture through the muscular process of the arytenoid attaching anteriorly to the thyroid ala. In contrast with the suture direction of this technique, a new paramedian approach to arytenoid adduction anchors anteroinferiorly to the cricoid cartilage, mimicking the force action of the lateral cricoarytenoid muscle (the major adductor of the larynx). This study investigated the influence of these changes in suture direction on the vocal fold level as well as the vocal outcomes in these two techniques of arytenoid adduction.

STUDY DESIGN

A prospective clinical series.

METHODS

Thirty patients with unilateral paralytic dysphonia underwent medialization laryngoplasty with arytenoid adduction and strap muscle transposition. Under local anesthesia, the thyroid lamina on the involved side was paramedially separated. The inner perichondrium was carefully elevated away from the overlying thyroid cartilage, carrying the dissection posteriorly to the level of the superior and inferior cornua. The lamina was retracted laterally, the inner perichondrium was opened near the midpoint, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 Prolene suture was placed through the muscular process and temporarily tied to the anterolateral aspect of the thyroid ala (AA-thyroid suture). Intraoperative acoustic and perceptual assessments were performed. After releasing the tie, the suture was anchored to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle (AA-cricoid suture). Voice assessments were repeated, and the outcomes of the two tests were compared. The choice of the type of arytenoid adduction suture was made intraoperatively according to which condition provided better vocal performance. After securing the suture, a bipedicled strap muscle flap was transposed into the space between the lamina and inner perichondrium and the thyroid cartilages sutured back into place.

RESULTS

The intraoperative acoustic and perceptual assessments revealed the vocal performance was significantly better with AA-cricoid suture than the AA-thyroid suture in this series. No major complications occurred in the study.

CONCLUSION

This study suggests that arytenoid adduction with suture attachment along the longitudinal axis of the lateral cricoarytenoid muscle to the cricoid cartilage is more physiologic and effective than that attaching the suture to the thyroid ala. A paramedian approach to arytenoid adduction with or without strap muscle transposition is a safe and effective method for treatment of unilateral paralytic dysphonia.

Authors+Show Affiliations

Department of Otolaryngology and voice center, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan. usgniy@cgmh.org.twNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16222189

Citation

Su, Chih-Ying, et al. "Functional Significance of Arytenoid Adduction With the Suture Attaching to Cricoid Cartilage Versus to Thyroid Cartilage for Unilateral Paralytic Dysphonia." The Laryngoscope, vol. 115, no. 10, 2005, pp. 1752-9.
Su CY, Tsai SS, Chuang HC, et al. Functional significance of arytenoid adduction with the suture attaching to cricoid cartilage versus to thyroid cartilage for unilateral paralytic dysphonia. Laryngoscope. 2005;115(10):1752-9.
Su, C. Y., Tsai, S. S., Chuang, H. C., & Chiu, J. F. (2005). Functional significance of arytenoid adduction with the suture attaching to cricoid cartilage versus to thyroid cartilage for unilateral paralytic dysphonia. The Laryngoscope, 115(10), 1752-9.
Su CY, et al. Functional Significance of Arytenoid Adduction With the Suture Attaching to Cricoid Cartilage Versus to Thyroid Cartilage for Unilateral Paralytic Dysphonia. Laryngoscope. 2005;115(10):1752-9. PubMed PMID: 16222189.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional significance of arytenoid adduction with the suture attaching to cricoid cartilage versus to thyroid cartilage for unilateral paralytic dysphonia. AU - Su,Chih-Ying, AU - Tsai,Shang-Shyue, AU - Chuang,Hui-Ching, AU - Chiu,Jeng-Fen, PY - 2005/10/14/pubmed PY - 2006/1/21/medline PY - 2005/10/14/entrez SP - 1752 EP - 9 JF - The Laryngoscope JO - Laryngoscope VL - 115 IS - 10 N2 - OBJECTIVE: In the treatment of unilateral paralytic dysphonia, traditional arytenoid adduction is designed to place suture through the muscular process of the arytenoid attaching anteriorly to the thyroid ala. In contrast with the suture direction of this technique, a new paramedian approach to arytenoid adduction anchors anteroinferiorly to the cricoid cartilage, mimicking the force action of the lateral cricoarytenoid muscle (the major adductor of the larynx). This study investigated the influence of these changes in suture direction on the vocal fold level as well as the vocal outcomes in these two techniques of arytenoid adduction. STUDY DESIGN: A prospective clinical series. METHODS: Thirty patients with unilateral paralytic dysphonia underwent medialization laryngoplasty with arytenoid adduction and strap muscle transposition. Under local anesthesia, the thyroid lamina on the involved side was paramedially separated. The inner perichondrium was carefully elevated away from the overlying thyroid cartilage, carrying the dissection posteriorly to the level of the superior and inferior cornua. The lamina was retracted laterally, the inner perichondrium was opened near the midpoint, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 Prolene suture was placed through the muscular process and temporarily tied to the anterolateral aspect of the thyroid ala (AA-thyroid suture). Intraoperative acoustic and perceptual assessments were performed. After releasing the tie, the suture was anchored to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle (AA-cricoid suture). Voice assessments were repeated, and the outcomes of the two tests were compared. The choice of the type of arytenoid adduction suture was made intraoperatively according to which condition provided better vocal performance. After securing the suture, a bipedicled strap muscle flap was transposed into the space between the lamina and inner perichondrium and the thyroid cartilages sutured back into place. RESULTS: The intraoperative acoustic and perceptual assessments revealed the vocal performance was significantly better with AA-cricoid suture than the AA-thyroid suture in this series. No major complications occurred in the study. CONCLUSION: This study suggests that arytenoid adduction with suture attachment along the longitudinal axis of the lateral cricoarytenoid muscle to the cricoid cartilage is more physiologic and effective than that attaching the suture to the thyroid ala. A paramedian approach to arytenoid adduction with or without strap muscle transposition is a safe and effective method for treatment of unilateral paralytic dysphonia. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/16222189/Functional_significance_of_arytenoid_adduction_with_the_suture_attaching_to_cricoid_cartilage_versus_to_thyroid_cartilage_for_unilateral_paralytic_dysphonia_ L2 - https://doi.org/10.1097/01.mlg.0000172203.28583.63 DB - PRIME DP - Unbound Medicine ER -