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Arytenoid abduction for bilateral vocal fold immobility.
Curr Opin Otolaryngol Head Neck Surg. 2011 Dec; 19(6):428-33.CO

Abstract

PURPOSE OF REVIEW

The pathophysiology of bilateral vocal fold immobility includes two broad categories: mechanical fixation and neurogenic paralysis. A mobile arytenoid can be surgically abducted, and this procedure has been reported as a treatment for patients with bilateral neurogenic laryngeal paralysis. This article reviews the theoretical basis and clinical outcomes of this procedure.

RECENT FINDINGS

Two concepts form the theoretical basis for arytenoid abduction. First, in most cases of neurogenic paralysis, laryngeal muscles are not denervated; there is considerable residual or regenerated function of adductor muscles. The vocal fold lies near the midline, because there is inadequate force to abduct the vocal fold. Second, the cricoarytenoid joint is multiaxial. The posterior cricoarytenoid (PCA) muscle rotates the arytenoid about an oblique axis to pull the vocal process laterally and superiorly, while the axis of adduction is nearly vertical. Thus, surgical abduction of the arytenoid, by simulating contraction of the PCA muscle, should not preclude active adduction during phonation or swallow. Surgical arytenoid abduction has been reported to improve the airway in many patients with bilateral laryngeal paralysis, with little or no impairment of vocal function. It is less successful in patients with inspiratory adductor muscle activity, long-term immobility, or previous procedures to statically enlarge the glottis.

SUMMARY

Arytenoid abduction is a promising treatment for selected patients with bilateral neurogenic laryngeal paralysis.

Authors+Show Affiliations

Southern Illinois University School of Medicine, Springfield, Illinois 62794-9662, USA. gwoodson@siumed.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22001662

Citation

Woodson, Gayle. "Arytenoid Abduction for Bilateral Vocal Fold Immobility." Current Opinion in Otolaryngology & Head and Neck Surgery, vol. 19, no. 6, 2011, pp. 428-33.
Woodson G. Arytenoid abduction for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg. 2011;19(6):428-33.
Woodson, G. (2011). Arytenoid abduction for bilateral vocal fold immobility. Current Opinion in Otolaryngology & Head and Neck Surgery, 19(6), 428-33. https://doi.org/10.1097/MOO.0b013e32834cd564
Woodson G. Arytenoid Abduction for Bilateral Vocal Fold Immobility. Curr Opin Otolaryngol Head Neck Surg. 2011;19(6):428-33. PubMed PMID: 22001662.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Arytenoid abduction for bilateral vocal fold immobility. A1 - Woodson,Gayle, PY - 2011/10/18/entrez PY - 2011/10/18/pubmed PY - 2012/9/21/medline SP - 428 EP - 33 JF - Current opinion in otolaryngology & head and neck surgery JO - Curr Opin Otolaryngol Head Neck Surg VL - 19 IS - 6 N2 - PURPOSE OF REVIEW: The pathophysiology of bilateral vocal fold immobility includes two broad categories: mechanical fixation and neurogenic paralysis. A mobile arytenoid can be surgically abducted, and this procedure has been reported as a treatment for patients with bilateral neurogenic laryngeal paralysis. This article reviews the theoretical basis and clinical outcomes of this procedure. RECENT FINDINGS: Two concepts form the theoretical basis for arytenoid abduction. First, in most cases of neurogenic paralysis, laryngeal muscles are not denervated; there is considerable residual or regenerated function of adductor muscles. The vocal fold lies near the midline, because there is inadequate force to abduct the vocal fold. Second, the cricoarytenoid joint is multiaxial. The posterior cricoarytenoid (PCA) muscle rotates the arytenoid about an oblique axis to pull the vocal process laterally and superiorly, while the axis of adduction is nearly vertical. Thus, surgical abduction of the arytenoid, by simulating contraction of the PCA muscle, should not preclude active adduction during phonation or swallow. Surgical arytenoid abduction has been reported to improve the airway in many patients with bilateral laryngeal paralysis, with little or no impairment of vocal function. It is less successful in patients with inspiratory adductor muscle activity, long-term immobility, or previous procedures to statically enlarge the glottis. SUMMARY: Arytenoid abduction is a promising treatment for selected patients with bilateral neurogenic laryngeal paralysis. SN - 1531-6998 UR - https://www.unboundmedicine.com/medline/citation/22001662/Arytenoid_abduction_for_bilateral_vocal_fold_immobility_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=22001662.ui DB - PRIME DP - Unbound Medicine ER -