Pillutla P, Zhang Z, Chhetri DK. Effects of Arytenoid Adduction Suture Position on Voice Production and Quality.
Laryngoscope 2020;
131:846-852. [PMID:
32710654 DOI:
10.1002/lary.28903]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS
Arytenoid adduction (AA) is performed to treat unilateral vocal fold paralysis with a large posterior glottal gap. However, the voice effects of AA suture position remain unclear. This study aimed to evaluate voice production and quality as a function of AA suture position on the thyroid ala in a neuromuscularly intact in vivo larynx.
STUDY DESIGN
Animal model.
METHODS
Unilateral recurrent laryngeal nerve and vagal paralysis were modeled in two canines. AA suture position was varied across five equidistant positions on the anterior inferior thyroid ala, from a paramedian position anteriorly to the oblique line posteriorly. Phonation was performed over 8 × 8 graded level combinations of recurrent and superior laryngeal nerve stimulation per suture position. The primary outcome was percent successful phonatory conditions. Secondary outcomes included fundamental frequency (F0), phonation onset pressure (PTP), cepstral peak prominence (CPP), and laryngeal posture.
RESULTS
Anterior suture positions resulted in a greater percentage of successful phonatory conditions compared to posterior sutures. Suture position 2, located at the anterior inferior thyroid ala, resulted in the highest percentage of successful phonatory conditions, lowest PTP, and lower muscle activation levels to achieve higher CPP. Posterior sutures resulted in wider glottal gap and more effective F0 and vocal fold strain increase with cricothyroid muscle contraction, but with fewer successful phonatory conditions and higher PTP. Trends were consistent across both paralysis types.
CONCLUSIONS
AA suture placed in the anterior inferior thyroid ala resulted in the best acoustic, aerodynamic, and voice quality outcomes. This study provides scientific evidence for maintaining current clinical practice.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:846-852, 2021.
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