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A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility.
Laryngoscope. 2015 Nov; 125(11):2522-9.L

Abstract

OBJECTIVE

Comparison of different endoscopic glottis-widening procedures designed for bilateral vocal cord immobility (BVCI) is a challenge. This is because a statistically efficient analysis and comparable clinical series is hard to obtain considering the variable aspects of the results and the evaluation methods. This study of a large number of cadaver larynges provides comparable, objective data for the evaluation of the possible postoperative breathing and voicing function.

STUDY DESIGN

A morphometric study was performed on 50 male and 50 female larynges to compare the different suture lateralization and resection procedures.

METHODS

The postoperative characteristic of glottic configuration was evaluated following vocal cord laterofixation, endolaryngeal arytenoid abduction lateropexy (EAAL), Schobel's external lateralization procedure (SELP), transverse cordotomy (TC), and medial and total arytenoidectomies (AE). The glottic area and the parameters determining the phoniatric outcomes were assessed by a digital image analyzer program.

RESULTS

Improvement of glottic area was observed after all procedures, but arytenoid abduction procedures were significantly the most effective. However, the smallest vocal cord angles were found in TC and AE; the injury of the voicing structures results in a deterioration of vocal mechanics and can be reasonably assumed to negatively influence the voice. Endolaryngeal arytenoid abduction lateropexy and SELP may provide the best phonation closure when residual adduction regeneration can occur.

CONCLUSION

This study demonstrates the complexity of the correct surgical decision making in BVCI. Procedures that utilize physiological abduction of the arytenoid cartilage seem to be more advantageous, especially if recovery of adductor function occurs.

LEVEL OF EVIDENCE

N/A.

Authors+Show Affiliations

Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26059854

Citation

Szakács, László, et al. "A Comparison Between Transoral Glottis-widening Techniques for Bilateral Vocal Fold Immobility." The Laryngoscope, vol. 125, no. 11, 2015, pp. 2522-9.
Szakács L, Sztanó B, Matievics V, et al. A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility. Laryngoscope. 2015;125(11):2522-9.
Szakács, L., Sztanó, B., Matievics, V., Bere, Z., Bach, A., Castellanos, P. F., & Rovó, L. (2015). A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility. The Laryngoscope, 125(11), 2522-9. https://doi.org/10.1002/lary.25401
Szakács L, et al. A Comparison Between Transoral Glottis-widening Techniques for Bilateral Vocal Fold Immobility. Laryngoscope. 2015;125(11):2522-9. PubMed PMID: 26059854.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility. AU - Szakács,László, AU - Sztanó,Balázs, AU - Matievics,Vera, AU - Bere,Zsófia, AU - Bach,Adam, AU - Castellanos,Paul F, AU - Rovó,László, Y1 - 2015/06/08/ PY - 2015/01/08/received PY - 2015/04/24/revised PY - 2015/05/01/accepted PY - 2015/6/11/entrez PY - 2015/6/11/pubmed PY - 2016/2/9/medline KW - Arytenoid abduction lateropexy KW - arytenoidectomy KW - bilateral vocal cord immobility KW - bilateral vocal cord motion impairment KW - endoscopic laryngeal microsurgery KW - glottis-enlarging procedures KW - transverse cordotomy KW - vocal cord paralysis KW - vocal cord suture lateralization SP - 2522 EP - 9 JF - The Laryngoscope JO - Laryngoscope VL - 125 IS - 11 N2 - OBJECTIVE: Comparison of different endoscopic glottis-widening procedures designed for bilateral vocal cord immobility (BVCI) is a challenge. This is because a statistically efficient analysis and comparable clinical series is hard to obtain considering the variable aspects of the results and the evaluation methods. This study of a large number of cadaver larynges provides comparable, objective data for the evaluation of the possible postoperative breathing and voicing function. STUDY DESIGN: A morphometric study was performed on 50 male and 50 female larynges to compare the different suture lateralization and resection procedures. METHODS: The postoperative characteristic of glottic configuration was evaluated following vocal cord laterofixation, endolaryngeal arytenoid abduction lateropexy (EAAL), Schobel's external lateralization procedure (SELP), transverse cordotomy (TC), and medial and total arytenoidectomies (AE). The glottic area and the parameters determining the phoniatric outcomes were assessed by a digital image analyzer program. RESULTS: Improvement of glottic area was observed after all procedures, but arytenoid abduction procedures were significantly the most effective. However, the smallest vocal cord angles were found in TC and AE; the injury of the voicing structures results in a deterioration of vocal mechanics and can be reasonably assumed to negatively influence the voice. Endolaryngeal arytenoid abduction lateropexy and SELP may provide the best phonation closure when residual adduction regeneration can occur. CONCLUSION: This study demonstrates the complexity of the correct surgical decision making in BVCI. Procedures that utilize physiological abduction of the arytenoid cartilage seem to be more advantageous, especially if recovery of adductor function occurs. LEVEL OF EVIDENCE: N/A. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/26059854/A_comparison_between_transoral_glottis_widening_techniques_for_bilateral_vocal_fold_immobility_ L2 - https://doi.org/10.1002/lary.25401 DB - PRIME DP - Unbound Medicine ER -