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A "fenestration approach" for arytenoid adduction through the thyroid ala combined with type I thyroplasty.
Laryngoscope. 2007 Oct; 117(10):1882-7.L

Abstract

OBJECTIVE

To develop and evaluate the voice outcomes of an approach of arytenoid adduction (AA) through a fenestration of the thyroid ala for unilateral vocal cord paralysis.

STUDY DESIGN

Twelve consecutive patients with severe unilateral vocal cord paralysis, whose maximum phonation times (MPTs) were less than or equal to 5 seconds, underwent laryngoplasty using an approach of AA performed through a fenestration of the thyroid ala combined with type I thyroplasty.

METHOD

Two surgical windows were made in the lower part of the thyroid ala. The anterior window was for typical type I thyroplasty, and the posterior window was for AA. AA was performed by pulling the lateral cricoarytenoid muscle (LCA) (5 patients) or muscular process (7 patients) through the posterior fenestration in the contractile direction of the LCA without releasing the cricoarytenoid joint. The operation was performed under local anesthesia with sedation except in two patients who underwent general anesthesia using a laryngeal mask. The vocal cord medialization was confirmed endoscopically during the operation. For all patients, the MPT and mean airflow rate (MFR) were measured before and after the operation. The postoperative voices were analyzed using shimmer and jitter.

RESULT

All patients achieved a MPT of over 12 seconds. The MFR, which ranged from 340 to 1902 mL/second before the operation, improved to less than 200 mL/second, except in one patient whose MFR was 210 mL/second. Shimmer and jitter improved significantly after the operation. Perceptual evaluation using the GRBAS (grade, roughness, breathiness, aesthenia, strain) scale also improved significantly.

CONCLUSION

A fenestration-based approach simplified the combination of AA and type I thyroplasty because the two treatments could be performed in the same operating field and provided good voice improvement. Pulling the AA braid in the contractile direction of the LCA and endoscopic vocal cord observation during surgery may have contributed to the positive results.

Authors+Show Affiliations

Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan. tokachanman@aol.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17690612

Citation

Tokashiki, Ryoji, et al. "A "fenestration Approach" for Arytenoid Adduction Through the Thyroid Ala Combined With Type I Thyroplasty." The Laryngoscope, vol. 117, no. 10, 2007, pp. 1882-7.
Tokashiki R, Hiramatsu H, Tsukahara K, et al. A "fenestration approach" for arytenoid adduction through the thyroid ala combined with type I thyroplasty. Laryngoscope. 2007;117(10):1882-7.
Tokashiki, R., Hiramatsu, H., Tsukahara, K., Kanebayashi, H., Nakamura, M., Motohashi, R., Yamada, T., & Suzuki, M. (2007). A "fenestration approach" for arytenoid adduction through the thyroid ala combined with type I thyroplasty. The Laryngoscope, 117(10), 1882-7.
Tokashiki R, et al. A "fenestration Approach" for Arytenoid Adduction Through the Thyroid Ala Combined With Type I Thyroplasty. Laryngoscope. 2007;117(10):1882-7. PubMed PMID: 17690612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A "fenestration approach" for arytenoid adduction through the thyroid ala combined with type I thyroplasty. AU - Tokashiki,Ryoji, AU - Hiramatsu,Hiroyuki, AU - Tsukahara,Kiyoaki, AU - Kanebayashi,Hidenori, AU - Nakamura,Mari, AU - Motohashi,Rei, AU - Yamada,Tetsuya, AU - Suzuki,Mamoru, PY - 2007/8/11/pubmed PY - 2007/12/6/medline PY - 2007/8/11/entrez SP - 1882 EP - 7 JF - The Laryngoscope JO - Laryngoscope VL - 117 IS - 10 N2 - OBJECTIVE: To develop and evaluate the voice outcomes of an approach of arytenoid adduction (AA) through a fenestration of the thyroid ala for unilateral vocal cord paralysis. STUDY DESIGN: Twelve consecutive patients with severe unilateral vocal cord paralysis, whose maximum phonation times (MPTs) were less than or equal to 5 seconds, underwent laryngoplasty using an approach of AA performed through a fenestration of the thyroid ala combined with type I thyroplasty. METHOD: Two surgical windows were made in the lower part of the thyroid ala. The anterior window was for typical type I thyroplasty, and the posterior window was for AA. AA was performed by pulling the lateral cricoarytenoid muscle (LCA) (5 patients) or muscular process (7 patients) through the posterior fenestration in the contractile direction of the LCA without releasing the cricoarytenoid joint. The operation was performed under local anesthesia with sedation except in two patients who underwent general anesthesia using a laryngeal mask. The vocal cord medialization was confirmed endoscopically during the operation. For all patients, the MPT and mean airflow rate (MFR) were measured before and after the operation. The postoperative voices were analyzed using shimmer and jitter. RESULT: All patients achieved a MPT of over 12 seconds. The MFR, which ranged from 340 to 1902 mL/second before the operation, improved to less than 200 mL/second, except in one patient whose MFR was 210 mL/second. Shimmer and jitter improved significantly after the operation. Perceptual evaluation using the GRBAS (grade, roughness, breathiness, aesthenia, strain) scale also improved significantly. CONCLUSION: A fenestration-based approach simplified the combination of AA and type I thyroplasty because the two treatments could be performed in the same operating field and provided good voice improvement. Pulling the AA braid in the contractile direction of the LCA and endoscopic vocal cord observation during surgery may have contributed to the positive results. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/17690612/A_"fenestration_approach"_for_arytenoid_adduction_through_the_thyroid_ala_combined_with_type_I_thyroplasty_ L2 - https://doi.org/10.1097/MLG.0b013e3180d09ef9 DB - PRIME DP - Unbound Medicine ER -