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Widening of posterior glottis through rotation of the arytenoid on its axis: Report of nine cases.
Am J Otolaryngol. 2018 Sep - Oct; 39(5):536-541.AJ

Abstract

INTRODUCTION

Bilateral vocal folds' immobility is a challenge in laryngology. Multiple procedures have been proposed to improve breathing by statically enlarging the glottal airway, what also results in loss of voice and aspiration. We proposed a technique to enlarge the posterior glottis by rotating the arytenoids on its axis, imitating the function of the posterior cricoarytenoid muscle, with the objective of evaluating the results regarding decannulation, voice quality, and bronchoaspiration.

METHODS

This study is a clinical case series of patients with bilateral vocal fold paralysis who underwent an arytenoid rotation surgery at a single tertiary university care institution between 2011 and 2017. Data were prospectively collected and was complemented with information from medical charts. Patients were assessed for decannulation, dyspnea, posterior glottic opening, quality of voice, and swallowing disorders.

RESULTS

Nine patients were included in the study. Out of three patients who required tracheostomy, two were successfully decannulated. Six patients reported a significant improvement in their dyspnea, while four patients reported a worsening of their voice. The stroboscopy evidenced a posterior glottic opening of at least 7 mm in six patients. Eight patients had no aspiratory symptoms, and the acoustic analysis showed that only one patient has a normal voice.

CONCLUSION

The arytenoid rotation on its axis by imitating the posterior cricoarytenoid muscle preserves the physiological functions of the larynx, which allows sufficient opening of the posterior glottis for breathing, and could alter in a lesser extent the anterior glottis to maintain a good quality of voice and swallowing.

Authors+Show Affiliations

Airway Surgery Department, Fundación Valle del Lili, Cali, Colombia; School of Health Science, Universidad ICESI, Cali, Colombia. Electronic address: luisfernandotintinago@gmail.com.Airway Surgery Department, Fundación Valle del Lili, Cali, Colombia; School of Health Science, Universidad ICESI, Cali, Colombia.Airway Surgery Department, Fundación Valle del Lili, Cali, Colombia.School of Health Science, Universidad ICESI, Cali, Colombia.School of Health Science, Universidad ICESI, Cali, Colombia.School of Health Science, Universidad ICESI, Cali, Colombia.Phonoaudiology Department, Fundación Valle del Lili, Cali, Colombia.Clinical Research Center, Fundación Valle del Lili, Cali, Colombia.Airway Surgery Department, Fundación Valle del Lili, Cali, Colombia; Clinical Research Center, Fundación Valle del Lili, Cali, Colombia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29898859

Citation

Tintinago, Luis F., et al. "Widening of Posterior Glottis Through Rotation of the Arytenoid On Its Axis: Report of Nine Cases." American Journal of Otolaryngology, vol. 39, no. 5, 2018, pp. 536-541.
Tintinago LF, Victoria W, Candelo E, et al. Widening of posterior glottis through rotation of the arytenoid on its axis: Report of nine cases. Am J Otolaryngol. 2018;39(5):536-541.
Tintinago, L. F., Victoria, W., Candelo, E., Diaz, J. C., Arce, J. C., Aristizabal, L. M., Sanz, C., Montes, M. C., & Velez-Esquivia, M. A. (2018). Widening of posterior glottis through rotation of the arytenoid on its axis: Report of nine cases. American Journal of Otolaryngology, 39(5), 536-541. https://doi.org/10.1016/j.amjoto.2018.06.005
Tintinago LF, et al. Widening of Posterior Glottis Through Rotation of the Arytenoid On Its Axis: Report of Nine Cases. Am J Otolaryngol. 2018 Sep - Oct;39(5):536-541. PubMed PMID: 29898859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Widening of posterior glottis through rotation of the arytenoid on its axis: Report of nine cases. AU - Tintinago,Luis F, AU - Victoria,William, AU - Candelo,Estephania, AU - Diaz,Juan Camilo, AU - Arce,Juan Carlos, AU - Aristizabal,Luis Miguel, AU - Sanz,Claudia, AU - Montes,Maria Claudia, AU - Velez-Esquivia,Maria A, Y1 - 2018/06/05/ PY - 2018/02/15/received PY - 2018/05/30/revised PY - 2018/06/03/accepted PY - 2018/6/15/pubmed PY - 2018/12/21/medline PY - 2018/6/15/entrez KW - Arytenoid cartilage KW - Bilateral paralysis KW - Surgery KW - Vocal cord paralysis SP - 536 EP - 541 JF - American journal of otolaryngology JO - Am J Otolaryngol VL - 39 IS - 5 N2 - INTRODUCTION: Bilateral vocal folds' immobility is a challenge in laryngology. Multiple procedures have been proposed to improve breathing by statically enlarging the glottal airway, what also results in loss of voice and aspiration. We proposed a technique to enlarge the posterior glottis by rotating the arytenoids on its axis, imitating the function of the posterior cricoarytenoid muscle, with the objective of evaluating the results regarding decannulation, voice quality, and bronchoaspiration. METHODS: This study is a clinical case series of patients with bilateral vocal fold paralysis who underwent an arytenoid rotation surgery at a single tertiary university care institution between 2011 and 2017. Data were prospectively collected and was complemented with information from medical charts. Patients were assessed for decannulation, dyspnea, posterior glottic opening, quality of voice, and swallowing disorders. RESULTS: Nine patients were included in the study. Out of three patients who required tracheostomy, two were successfully decannulated. Six patients reported a significant improvement in their dyspnea, while four patients reported a worsening of their voice. The stroboscopy evidenced a posterior glottic opening of at least 7 mm in six patients. Eight patients had no aspiratory symptoms, and the acoustic analysis showed that only one patient has a normal voice. CONCLUSION: The arytenoid rotation on its axis by imitating the posterior cricoarytenoid muscle preserves the physiological functions of the larynx, which allows sufficient opening of the posterior glottis for breathing, and could alter in a lesser extent the anterior glottis to maintain a good quality of voice and swallowing. SN - 1532-818X UR - https://www.unboundmedicine.com/medline/citation/29898859/Widening_of_posterior_glottis_through_rotation_of_the_arytenoid_on_its_axis:_Report_of_nine_cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0709(18)30159-5 DB - PRIME DP - Unbound Medicine ER -