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Motohashi R, Tokashiki R, Sakurai E, Saito Y, Shoji Y, Tsukahara K. Fenestration Approach for Arytenoid Adduction in Unilateral Vocal Fold Paralysis. J Voice 2024:S0892-1997(24)00147-4. [PMID: 38839466 DOI: 10.1016/j.jvoice.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Several surgical techniques have been reported for the treatment of unilateral vocal fold paralysis (UVFP). Although the fenestration approach has recently been applied for arytenoid adduction (AA) in some cases, long-term large-cohort studies on its usefulness are lacking. Therefore, this study aimed to evaluate the long-term voice outcomes of this technique in patients with UVFP. STUDY DESIGN Retrospective study. METHODS A total of 168 patients with UVFP underwent laryngoplasty comprising AA performed through fenestration of the thyroid ala combined with a type I thyroplasty (TPI). The maximum phonation time (MPT) and mean airflow rate (MFR) were measured before and after surgery, and voice analysis included an estimation of shimmer and jitter. Anterior and posterior surgical windows were created in the lower thyroid ala and were used for typical TPI and AA, respectively. The window locations were determined based on three-dimensional computed tomography data. AA was performed by pulling the muscular process of the arytenoid cartilage toward the lateral cricoarytenoid muscle through the posterior window without releasing the cricothyroid joint. All surgeries were performed under local anesthesia, and medialization was endoscopically confirmed. RESULTS Postoperative MPT >10 seconds was achieved in 156 of the 168 patients. Postoperatively, MFR improved to <250 mL/s in all but two patients, and MPT, MFR, jitter, and shimmer significantly improved in all patients. Furthermore, perceptual evaluation using the Grade, Roughness, Breathiness, Asthenia, and Strain scale revealed significant improvement in all patients. CONCLUSIONS The fenestration approach preserves the cricothyroid joint and does not open the cricoarytenoid joint; therefore, the laryngeal cartilage is stabilized, and no distortion of the laryngeal framework occurs. Our results showed that combined AA and TPI via the fenestration approach provided stable long-term postoperative voice improvement in patients with UVFP. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Ray Motohashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Ryoji Tokashiki
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan; Shinjuku Voice Clinic, Tokyo, Japan
| | - Eriko Sakurai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yu Saito
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Shoji
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
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Long-term voice outcomes of laryngeal framework surgery for unilateral vocal fold paralysis. Eur Arch Otorhinolaryngol 2021; 279:1957-1965. [PMID: 34787700 DOI: 10.1007/s00405-021-07177-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the short- and long-term voice outcomes after unilateral medialization thyroplasty (MT) and unilateral medialization thyroplasty with arytenoid adduction (MT + AA) in patients with unilateral vocal fold paralysis. METHODS Voice outcomes were assessed preoperatively, and postoperatively at 3 and 12 months according to a standardized protocol. Voice assessment was performed using Voice Handicap Index (VHI), GRBAS Grade, Maximum Phonation Time (MPT), s/z-ratio and subjective numeric rating scales on voice quality, effort, performance and influence on life. RESULTS Sixty-one patients were included (34 MT and 27 MT + AA). Significant pre- to postoperative improvements were seen in all voice outcome parameters. No significant differences in post-operative values were identified between the groups. CONCLUSION Based on our findings, we conclude that patients with unilateral vocal fold paralysis who undergo MT and MT + AA achieve comparable and significant long time voice improvement, although voices do not completely normalize. We also conclude that this does not mean that AA is a superfluous procedure, but can indicate the accurate identification of patients in need of the additional AA procedure based on clinical parameters.
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Rapoport SK, Murry T, Woo P. Voice assessment of fat injection vs medialization laryngoplasty in nonparalytic dysphonia. Laryngoscope Investig Otolaryngol 2021; 6:453-457. [PMID: 34195367 PMCID: PMC8223466 DOI: 10.1002/lio2.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/20/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Compare long-term voice outcomes in patients treated with FIM or BML for nonparalytic dysphonia. There is controversy whether fat injection medialization (FIM) is a durable alternative to bilateral medialization laryngoplasty (BML) for nonparalytic dysphonia (atrophy, sulcus, scar, paresis). Both interventions yield improved voice quality, yet comparison of patients' long-term perceptions of their voice after these procedures has not been performed. METHODS Retrospective review of patients who underwent FIM or BML for nonparalytic dysphonia was performed from 2008-2018. Charts were reviewed for demographic information, preoperative diagnosis, intervention, Voice Handicap Index-10 (VHI-10), and follow-up time. RESULTS Forty-nine patients met our criteria. Fifty procedures were performed (25 FIM, 25 BML). One patient underwent BML with subsequent FIM. There was no significant difference in pre-treatment or post-treatment VHI-10 scores between both groups (Pre-FIM 21 Post-FIM 10.28; Pre-BML 22.48, Post-BML 10.88). Total median follow-up time was 11.3 months (FIM 14.8 months, BML 9.5 months). Using VHI-10 scores recorded at each patient's latest follow-up visit, both groups demonstrated significant decrease (P < .05) compared to preoperative scores: VHI-10 decreased by a mean delta of 10.72 in the FIM group and 11.6 in the BML group. There was no significant difference in pre, post and change in VHI between groups. CONCLUSIONS In patients with nonparalytic dysphonia, FIM is a durable alternative to BML. Patients treated in both groups gained substantial improvement in vocal function. For both treatment groups, we should anticipate less than complete satisfaction with surgery and revision procedures in a minority of patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sarah K. Rapoport
- Department of Otolaryngology Head and Neck SurgeryMount Sinai Medical CenterNew YorkNew YorkUSA
| | - Thomas Murry
- Department of Otolaryngology‐Head and Neck SurgeryLoma Linda Health UniversityLoma LindaCaliforniaUSA
- Department of Otolaryngology‐Head and Neck SurgeryDrexel University College of MedicinePhiladelphiaPennsylvaniaUSA
| | - Peak Woo
- Department of Otolaryngology Head and Neck SurgeryMount Sinai Medical CenterNew YorkNew YorkUSA
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Abstract
Laryngeal framework surgery is an umbrella term for all phonosurgical procedures by which the cartilaginous structure of the larynx and thereby the position and tension of the vocal folds are changed. The aim is to improve the voice. By far the best known and most frequently performed operation is thyroplasty type 1 according to Isshiki, also known as medialization thyroplasty, which is indicated for treatment of glottic insufficiency. Although the first medialization thyroplasty was successfully performed by Payr in Germany in 1915, more than 100 years later, it is still not widely used in Germany.
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Affiliation(s)
- Markus Hess
- Medical Voice Center, Martinistraße 64, 20251, Hamburg, Deutschland.
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Arytenoid asymmetry: Is it the most predictive parameter for arytenoid adduction in unilateral vocal fold paralysis? The Journal of Laryngology & Otology 2021; 135:159-167. [PMID: 33593469 DOI: 10.1017/s0022215121000475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to establish arytenoid asymmetry as a pre-operative predictive parameter for arytenoid adduction surgery in unilateral vocal fold paralysis and thereafter identify the most predictive parameter for arytenoid adduction among the established parameters. METHODS A retrospective comparative study was undertaken. The 'arytenoid asymmetry angle' formed between skewed 'glottic' and 'interarytenoid' axes (traced along the plane of closure of the membranous and cartilaginous glottis, respectively) was quantified in pre-operative laryngoscopic images of 85 adults with unilateral vocal fold paralysis who underwent either type 1 thyroplasty (group 1) or type 1 thyroplasty with arytenoid adduction (group 2). The need for arytenoid adduction was determined intra-operatively based on subjective voice improvement and laryngoscopic results. RESULTS Arytenoid asymmetry (p < 0.0001), posterior phonatory gap (p = 0.001) and vertical level difference (p = 0.004) were significantly greater in group 2 (descending order of parameters). Arytenoid asymmetry angle showed a significant positive correlation with the latter two parameters. CONCLUSION Arytenoid asymmetry is the most predictive parameter for arytenoid adduction. An arytenoid asymmetry angle of more than or equal to 33.9⁰ is an indication for arytenoid adduction. This aids in pre-operative planning of arytenoid adduction.
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Yılmaz T, Kuşcu O. Hemorrhagic Complication After Thyroplasty and Arytenoid Adduction Leading to Tracheotomy. EAR, NOSE & THROAT JOURNAL 2019; 99:NP122-NP123. [PMID: 31296050 DOI: 10.1177/0145561319862789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Taner Yılmaz
- Department of Otolaryngology-Head & Neck Surgery, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oğuz Kuşcu
- Department of Otolaryngology-Head & Neck Surgery, 37515Hacettepe University Faculty of Medicine, Ankara, Turkey
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Zimmermann TM, Orbelo DM, Pittelko RL, Youssef SJ, Lohse CM, Ekbom DC. Voice outcomes following medialization laryngoplasty with and without arytenoid adduction. Laryngoscope 2018; 129:1876-1881. [PMID: 30582612 DOI: 10.1002/lary.27684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA). METHODS Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009-2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index-10 (VHI-10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE-V) were assessed. RESULTS Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI-10 scores (P < 0.001), and CAPE-V scores (P = 0.007). Baseline VHI-10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI-10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE-V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates. CONCLUSION Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1876-1881, 2019.
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Affiliation(s)
| | - Diana M Orbelo
- Department of Otorhinolaryngology, Rochester, Minnesota, U.S.A
| | | | | | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Rochester, Minnesota, U.S.A
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Surgical histoanatomy for adduction arytenopexy using injection laryngoplasty. The Journal of Laryngology & Otology 2018; 132:1143-1146. [PMID: 30558686 DOI: 10.1017/s002221511800213x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In order to improve a large posterior glottal gap and/or aspiration, injections of augmentation substances should not only be administered at the mid-membranous vocal fold in the thyroarytenoid muscle, but also at the cartilaginous portion of the vocal fold to make adduction arytenopexy possible. METHOD Ten adult human larynges were investigated using the whole-organ serial section technique. RESULTS Vertical thickness of the posterior aspect of the thyroarytenoid muscle was relatively thin (3.4 ± 0.4 mm), especially in females (3.2 ± 0.3 mm). Consequently, care should be taken to ensure the correct depth of needle placement. If the needle is placed too deep, augmentation substances are injected into the lateral cricoarytenoid muscle, located beneath the thyroarytenoid muscle, or into the paraglottic space, located inferolateral to the thyroarytenoid muscle. CONCLUSION The injection location and the amount of injected material should be modified based on the pathological conditions of the voice disorder and aspiration.
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Chang J, Schneider SL, Curtis J, Langenstein J, Courey MS, Yung KC. Outcomes of medialization laryngoplasty with and without arytenoid adduction. Laryngoscope 2017; 127:2591-2595. [PMID: 28699172 DOI: 10.1002/lary.26773] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/16/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the effect of medialization laryngoplasty (ML) performed alone compared to ML with arytenoid adduction (AA) on glottic gap and voice quality in unilateral vocal fold paralysis (UVFP) patients. STUDY DESIGN Retrospective case series. METHODS UVFP patients treated with ML alone and ML with AA at the University of California San Francisco Voice and Swallowing Center were identified. Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative examinations were digitally analyzed using ImageJ for normalized anterior and posterior glottic gap and voice samples graded with CAPE-V scores. RESULTS Forty-seven patients underwent ML and 27 patients underwent ML with AA. Normalized anterior gap (AG) improved in both ML (preop: 4.4 pixel units (u), postop: 0.8 u; P < 0.001) and ML with AA groups (preop: 3.3 u, postop 0.6 u; P < 0.001). There was no statistically significant difference in normalized AG values between treatment groups. Postoperative normalized posterior gap (PG) improved in the ML with AA group only (preop: 1.8 u, postop: 0.5 u; P = 0.01). Overall severity, roughness, and strain voice parameters had acceptable reliability for analysis. Overall severity improved in ML (preop: 54, postop: 27; P < 0.001) and ML with AA (preop: 44, postop: 24; P = 0.005). There was no statistically significant difference in any voice parameter between treatment groups. CONCLUSION UVFP patients undergoing ML may benefit from addition of AA when a large posterior glottic gap is present. In this study, ML with AA but not ML alone resulted in statistically significant improvement in PG. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2591-2595, 2017.
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Affiliation(s)
- Joseph Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - James Curtis
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Jonelyn Langenstein
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Mark S Courey
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Health System, New York, New York, U.S.A
| | - Katherine C Yung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
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Desuter G, Mertens B, Delchambre A, van Lith-Bijl J, van Benthem PP, Sjögren E. The larynx ruler to measure height and profile of vocal folds: a proof of concept. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:149-155. [PMID: 28740437 PMCID: PMC5505612 DOI: 10.2147/mder.s136561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Glottic leakage during phonation is a direct consequence of unilateral vocal fold (VF) paralysis. This air leakage can be in the horizontal plane and in the vertical plane. Presently, there is no easily applicable medical device allowing noninvasive, office-based measurement of the relative vertical position of the VFs. The larynx ruler (LR) is a laser-based measuring device that could meet the previously stated need, using a flexible endoscope. This study represents a proof of concept regarding the use of the LR in assessing VF relative positions in the vertical plane. MATERIALS AND METHODS One fresh male human cadaver larynx, free of neurologic and anatomic disease, was explored with the LR system through the operative channel of a flexible gastroenterology video-endoscope. The tip of the video-endoscope was located in the laryngeal vestibule. The right crico-arytenoid joint was posteriorly disarticulated. Tilting of the VF was obtained by pulling or pushing the arytenoid cartilage with a mosquito forceps fixed to the stump of the previously sectioned superior tip of the posterior crico-arytenoid muscle allowing anterior and posterior tilting of the arytenoid cartilage in order to induce an elevation or a depression of the VF process. Ten "push" and ten "pull" sessions were performed. The distance from the tip of the video-endoscope to each illuminated pixel of the laser beam was recorded. The level difference between the left and right VFs was measured for each recording. RESULTS Data provided by the LR were consistently in accordance with the movements applied on the VFs. The accuracy of 0.2 mm of the LR is compatible with the envisioned applications for the human larynx. CONCLUSION The LR system represents a feasible technique to evaluate respective vertical position of VFs in the human larynx. Technical limitations were identified that will require improvements before experimental use on human beings.
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Affiliation(s)
- Gauthier Desuter
- Otolaryngology, Head & Neck Surgery Department, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, the Netherlands
| | - Benjamin Mertens
- BEAMS Department, Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Alain Delchambre
- BEAMS Department, Ecole Polytechnique de Bruxelles, Université libre de Bruxelles, Brussels, Belgium
| | - Julie van Lith-Bijl
- Otolaryngology, Head & Neck Surgery Department, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Otolaryngology Department, Flevoziekenhuis, Almere, the Netherlands
| | - Peter Paul van Benthem
- Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, the Netherlands
| | - Elisabeth Sjögren
- Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, the Netherlands
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Fukuhara T, Morisaki T, Kataoka H, Miyake N, Taira K, Koyama S, Fujiwara K, Kitano H, Takeuchi H. Modifications to the Fenestration Approach for Arytenoid Adduction Under Local Anesthesia. J Voice 2016; 31:490-494. [PMID: 27916331 DOI: 10.1016/j.jvoice.2016.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/21/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We modified the fenestration approach for arytenoid adduction to make it easier to perform the surgery. The aim of this study was to evaluate the usefulness of our modifications, which included (1) use of an Alexis wound retractor (Applied Medical) to secure the surgical field through a small incision, and (2) use of a 12-mm, 1/2 R, insert-molded taper needle with 3-0 nylon suture to prevent damage to the arytenoid cartilage. STUDY DESIGN This is a retrospective non-randomized observational cross-sectional study. METHODS We compared the operative time and skin incision length between the conventional fenestration approach and our modified procedure, and verified the improvement of patients' voice by our procedure. RESULTS Seven patients underwent the conventional fenestration approach for arytenoid adduction with type I thyroplasty, whereas nine patients underwent our modified fenestration approach for arytenoid adduction with type I thyroplasty. The skin incision length with our modifications (median, 3.0 cm; interquartile range [IQR], 3.0-4.0) was significantly shorter than with the conventional procedure (median, 5.0 cm; IQR, 4.3-5.8) (P = 0.001). The operative time with our modifications (median, 95 minutes; IQR, 90-100) was significantly shorter than without our modifications (median, 115; IQR, 100-130) (P = 0.035). All patients who underwent our modified fenestration approach for arytenoid adduction had maximum phonation time greater than 11 seconds after surgery. CONCLUSIONS Our two distinctive modifications reduced the operative time and skin incision length for the fenestration approach, which improved the procedure by making it less invasive.
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Affiliation(s)
- Takahiro Fukuhara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
| | - Tsuyoshi Morisaki
- Center for Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Japan
| | - Hideyuki Kataoka
- Division of Medical Education, Department of Social Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Naritomo Miyake
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kenkichiro Taira
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Satoshi Koyama
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroya Kitano
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Kwon TK, Jeong WJ, Sung MW, Kim KH. Development of Endoscopic Arytenoid Adduction Using Cricoid Implant. Ann Otol Rhinol Laryngol 2016; 116:770-8. [DOI: 10.1177/000348940711601009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We sought to develop a less-invasive alternative to conventional arytenoid adduction using a cricoid implant. Methods: We performed a preliminary study with excised human and canine larynges. A nail-shaped stainless steel rod and an insertion device were designed for an in vivo animal trial. After unilateral recurrent laryngeal denervation surgery in 5 adult mongrel dogs, the implants were inserted endoscopically through a small mucosal incision over the cricoarytenoid joint. Acoustic and aerodynamic data were obtained from each animal before serial euthanasia followed by examination of the excised larynges. Results: The canine cricoid cartilage demonstrated adequate marrow space for implantation. We found that the arytenoid cartilage was successfully medialized and tightly fixed over a sufficient period of time just by inserting an implant in the cricoid cartilage. The animal study showed that the implantation procedure was relatively easy and relatively safe. Acoustic and aerodynamic studies confirmed the functional improvement of the voice. Histopathologic study revealed a favorable tissue response to the implant. Conclusions: Endoscopic arytenoid adduction using a cricoid implant is feasible and could be a noninvasive surgical option for the treatment of unilateral vocal fold paralysis.
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Sato K, Umeno H, Nakashima T. Autologous Fat Injection Laryngohypopharyngoplasty for Aspiration after Vocal Fold Paralysis. Ann Otol Rhinol Laryngol 2016; 113:87-92. [PMID: 14994760 DOI: 10.1177/000348940411300201] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Injection laryngoplasty is one of the procedures for treating unilateral vocal fold paralysis. This is a preliminary report on modified injection laryngoplasty, ie, injection of liposuctioned autologous fat into the larynx and hypopharynx of patients who have aspiration and voice disorders after vocal fold paralysis. Lipoinjection was performed in 3 patients with these complaints with the endolaryngeal microsurgical technique under general anesthesia. The locations of fat injection were the vocal fold, the false vocal fold, the aryepiglottic fold of the larynx, and the medial wall of the pyriform sinus of the hypopharynx. Lipoinjection into the vocal fold, false vocal fold, and aryepiglottic fold strengthened laryngeal closure. Lipoinjection, performed into the thyroarytenoid muscle lateral to the oblong fovea of the arytenoid cartilage, made arytenoid cartilage rotation possible, and consequently strengthened laryngeal closure. Lipoinjection into the medial wall of the pyriform sinus of the hypopharynx reduced its capacity; consequently, the amount of residual food retained in it was reduced and pharyngeal clearance on the affected side was improved. The longest follow-up among the 3 patients has been 24 months. Their aspiration and glottal incompetence have been improved by this operation. We conclude that modified injection laryngoplasty (laryngohypopharyngoplasty) is one of the surgical options for preventing aspiration after vocal fold paralysis.
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Affiliation(s)
- Kiminori Sato
- Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
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Sandwich Thyroplasty: A Novel Technique for Simplifying Medialization of Vocal Fold Using Silicone Implant in Paralytic Dysphonia with Modification of Thyroplasty Window. Indian J Otolaryngol Head Neck Surg 2015; 67:159-64. [PMID: 26075171 DOI: 10.1007/s12070-014-0761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022] Open
Abstract
A novel technique of thyroplasty-Sandwich thyroplasty-described, with modification of Isshiki's thyroplasty window to overcome the problems of securing and stabilising the silicone implant in the window thus simplifying the medialization of the vocal fold. Seventy five patients diagnosed with paralytic dysphonia of varied etiology, attending Sri Sathya Sai Institute of ORL, Guntur, India from January 2005 to January 2012, were subjected to this new technique. Medialization of vocal fold was achieved by sandwiching and stabilising a silicone implant between a superiorly based cartilaginous hinged door and the inner perichondrium of the modified thyroplasty window. Results were analysed based upon pre and postoperative voice handicap index, maximum phonation time readings and video-stroboscopic findings. The results were statistically significant with no untoward complications. Sandwich thyroplasty technique facilitated easier fixation and stabilization of silicone implant avoiding difficult and time consuming, techniques involving flanges or sutures.
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McCulloch TM, Hoffman MR, McAvoy KE, Jiang JJ. Initial investigation of anterior approach to arytenoid adduction in excised larynges. Laryngoscope 2013; 123:942-7. [PMID: 23400957 DOI: 10.1002/lary.23650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/29/2012] [Accepted: 07/17/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Arytenoid adduction (AA) can dramatically improve voice quality in patients with vocal fold paralysis (VFP); however, it is technically challenging. We present an anterior approach to AA, where GORE-TEX suture attached to curled wire is passed through the thyroid cartilage or cricothyroid membrane via a guide needle and used to manipulate the muscular process of the arytenoid. Performing AA via an anterior approach leads to comparable aerodynamic and acoustic outcomes compared to traditional AA in an excised larynx model. STUDY DESIGN Repeated measures with each larynx serving as its own control. METHODS We performed thyroplasty followed by traditional and anterior AA on excised larynges with simulated VFP. Aerodynamic and acoustic measurements were recorded. RESULTS Anterior AA significantly improved aerodynamic (phonation threshold power: P = .003) and acoustic parameters (percentage jitter: P = .028; percentage shimmer: P = .001; signal-to-noise ratio: P = .034) compared to VFP in this excised larynx model. Anterior AA and traditional AA produced comparable improvements in all parameters (phonation threshold power: P = .256; percentage jitter: P = .616; percentage shimmer: P = .281; signal-to-noise ratio: P = .970). CONCLUSIONS Anterior AA is an alternative to traditional AA that is easier to perform and produces comparable improvements in laryngeal function.
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Affiliation(s)
- Timothy M McCulloch
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
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Stow NW, Lee JW, Cole IE. Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask. Otolaryngol Head Neck Surg 2011; 146:266-71. [DOI: 10.1177/0194599811427811] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture. Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis. Setting. Tertiary referral teaching hospital in Sydney, Australia. Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life. Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time). Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months. Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure.
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Affiliation(s)
| | - Jennifer W. Lee
- Department of Otolaryngology, Royal North Shore Hospital, NSW Australia
| | - Ian E. Cole
- Department of Otolaryngology, St Vincent’s Hospital, NSW Australia
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Hess M, Schroeder D, Püschel K. Sling arytenoid adduction. Eur Arch Otorhinolaryngol 2011; 268:1023-8. [DOI: 10.1007/s00405-010-1429-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/08/2010] [Indexed: 11/28/2022]
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Rosow DE, Sulica L. Laryngoscopy of vocal fold paralysis: evaluation of consistency of clinical findings. Laryngoscope 2010; 120:1376-82. [PMID: 20564722 DOI: 10.1002/lary.20945] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngoscopy is the principal tool for the clinical assessment of vocal fold paralysis (VFP). Yet no consistent, unified vocabulary to describe laryngoscopic findings exists, compromising the evaluation and comparison of cases, outcomes, and treatment. The goal of this investigation was to evaluate laryngoscopic findings in VFP for inter- and intra-rater consistency. STUDY DESIGN Prospective survey-based study. METHODS Half-minute excerpts from stroboscopic exams of 22 patients with VFP were mailed to 22 fellowship-trained laryngologists. Each reviewer was sent exams in randomized order, with three random repeats included to determine intra-rater reliability. Twelve laryngoscopic criteria were assessed and recorded on preprinted sheets. Eleven criteria were binary in nature (yes/no); glottic insufficiency was rated on a four-point scale (none/mild/moderate/severe). Raters were blinded to clinical history, each other's ratings, and to their own previous ratings. Inter-rater agreement was calculated by Fleiss' kappa. RESULTS Twenty reviewers (91%) replied. Intra-rater reliability by reviewer ranged from 66% to 100% and by laryngoscopic criterion from 77% to 100%. Of the laryngoscopic criteria used, glottic insufficiency (kappa = 0.55), vocal fold bowing (kappa = 0.49), and salivary pooling (kappa = 0.45) showed moderate agreement between reviewers. Arytenoid stability (kappa = 0.1), arytenoid position (kappa = 0.12), and vocal fold height mismatch (kappa = 0.12) showed poor agreement. The remainder showed slight to fair agreement. CONCLUSIONS Inter-rater agreement on commonly used laryngoscopic criteria is generally fair to poor. Glottic insufficiency, vocal fold bowing, and salivary pooling demonstrated the most agreement among responding laryngologists. These findings suggest a need for a standardized descriptive scheme for laryngoscopic findings in VFP.
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Affiliation(s)
- David E Rosow
- Department of Otorhinolaryngology, Weill Cornell Medical College, New York, New York 10021, USA
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Kandogan T. Type III Thyroplasty for the Treatment of Glottic Gap in a Patient Undergoing Laryngofissure Cordectomy for Squamous Cell Carcinoma of the Vocal Fold: Technique and Outcome. EAR, NOSE & THROAT JOURNAL 2010. [DOI: 10.1177/014556131008900610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 44-year-old man presented with squamous cell carcinoma (T1aN0M0) on the left vocal fold and was prepared for a combined laryngofissure cordectomy and type III thyroplasty. The author performed both procedures together—not only to lower the tension on the healthy vocal fold, but also to determine whether the thyroplasty would successfully close the glottic gap created by the cordectomy, resulting in relatively fast improvement in the patient's voice. Satisfactory glottic closure and a satisfactory voice result were achieved rather quickly. The patient was satisfied with his new voice, both in the early and late postoperative periods.
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Affiliation(s)
- Tolga Kandogan
- From the Department of Otolaryngology & Head-Neck Surgery, Voice Center, Izmir Training and Research Hospital, Izmir Turkey
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Nito T, Ushio M, Kimura M, Yamaguchi T, Tayama N. Analyses of risk factors for postoperative airway compromise following arytenoid adduction. Acta Otolaryngol 2009; 128:1342-7. [PMID: 18607932 DOI: 10.1080/00016480801958303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION This study suggests that placing no drainage tube and postoperative bleeding are risk factors for postoperative airway compromise (PAC) following arytenoid adduction (AA). OBJECTIVES In this study, we aimed to elucidate the risk factors for PAC following AA. PATIENTS AND METHODS The data for 184 consecutive patients who underwent AA were analyzed retrospectively. Univariate and forward stepwise multivariate logistic regression analyses were performed. RESULTS Placing no drainage tube was a significant risk factor for PAC as determined by both univariate and multivariate analyses. Postoperative bleeding was a significant risk factor for severe airway compromise requiring emergency airway treatment.
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Mortensen M, Carroll L, Woo P. Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty: The role of the arytenoidopexy. Laryngoscope 2009; 119:827-31. [DOI: 10.1002/lary.20171] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
OBJECTIVES/HYPOTHESIS Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralyzed vocal fold but must be evaluated in light of potential complications following laryngeal framework surgery. STUDY DESIGN AND METHODS The charts of 237 patients who underwent unilateral vocal fold medialization surgery between July 1, 1991, and August 30, 1999, at a tertiary care cancer referral center were retrospectively reviewed. RESULTS There were 98 cases of type I thyroplasty alone and 96 cases of type I thyroplasty with arytenoid adduction. The two groups had similar patient characteristics. Mean time of surgery (45 vs. 73 min, P <.0001) and length of hospital stay (1.1 vs. 1.8 d, P <.0001) were increased when arytenoid adduction was performed. Overall improvement of symptoms was similar in both groups (93%-94%), but posterior glottic closure appeared subjectively improved when arytenoid adduction was used (P =.0054). Overall complication rates were slightly higher in the arytenoid adduction group (14% vs. 19%), primarily because of transient vocal fold edema and wound complications (9 vs. 19 cases), but the increase was not statistically significant (P =.1401). Complications warranting medical or surgical intervention occurred in 8% of cases. Two patients who underwent type I thyroplasty with arytenoid adduction required tracheotomy as a consequence of postoperative complications. The three patients who had extrusion of the implant underwent type I thyroplasty alone. CONCLUSION Using the appropriate technique, the potential benefits of improved glottic function following type I thyroplasty with arytenoid adduction outweigh the small risk of significant complications observed.
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Affiliation(s)
- M T Abraham
- Department of Otolaryngology, New York University School of Medicine, New York, NY, U.S.A
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Woo P, Pearl AW, Hsiung MW, Som P. Failed medialization laryngoplasty: management by revision surgery. Otolaryngol Head Neck Surg 2001; 124:615-21. [PMID: 11391250 DOI: 10.1177/019459980112400603] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the cause of immediate and late medialization laryngoplasty failures and to describe their management. METHODS A retrospective analysis was performed in 20 patients who underwent revision surgery after failed medialization laryngoplasty. Analysis was based on preoperative spiral CT scan, preoperative and postoperative videostrobolaryngoscopy, and phonatory function measures. RESULTS Three major types of failures were identified. The most common problem was arytenoid rotation with a persistent posterior glottic gap (11 of 20). Malposition or wrong size of the implants resulted in a lateralized vocal fold or false vocal fold medialization (6 of 20). Three patients had implants that were extruding. Late atrophy and bowing resulted in a glottal gap (2 of 20). One patient had fibrosis around the implant requiring removal. Spiral CT scan of the larynx located the implant precisely and showed the degree of arytenoid rotation. Patients with arytenoid rotation and posterior gap had revision medialization combined with arytenoid adduction. Revision medialization was performed in 11 patients, arytenoid adduction in 12 patients, lipoinjection in 2 patients, and 4 implants were removed. The voice was improved in 15 patients. Improved voice was correlated with improved phonation time and reduced phonatory airflow rates. CONCLUSION Immediate and late failures of medialization laryngoplasty are due to several possible causes. Revision surgery is feasible and highly successful. To select between the surgical alternatives work up should include preoperative analysis of vocal function, videostrobolaryngoscopic analysis, and spiral CT of the larynx.
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Affiliation(s)
- P Woo
- Department of Otolaryngology, The Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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