A new procedure of arytenoid adduction combined with type I thyroplasty under general anesthesia using a laryngeal mask

Abstract

Laryngeal framework surgery is usually performed under local anesthesia. However, some patients are unable to tolerate extended surgery. A case of an 82-year-old woman who underwent medialization thyroplasty and arytenoid adduction of direct lateral cricoarytenoid (LCA) muscle pulling at the same time under general anesthesia using a laryngeal mask is reported. Endoscopic observation through the laryngeal mask allows direct visual control of the vocal cord. The LCA pulling method does not touch the posterior border of the thyroid cartilage so that the laryngeal mask does not disturb the arytenoid adducts.

A “Fenestration Approach” for Arytenoid Adduction Through the Thyroid Ala Combined With Type I Thyroplasty

“…If the posterior portion is removed, the hypopharyngeal mucosa is extended outward from the bulge caused by the laryngeal mask. The extended mucosa makes it difficult to expose the MP and the LCA (refer to our previous report 8 for more information).…”

“…However, 2 of the 12 patients were unable to tolerate the extended surgery under local anesthesia for various reasons. These surgeries were performed under general anesthesia using a laryngeal mask, which enabled endoscopic observation of the vocal fold medialization during surgery 8 …”

“…For two patients, the operation was performed under general anesthesia using a laryngeal mask that enabled endoscopic observation of the vocal fold. Endoscopic confirmation of vocal fold adduction is very important because the patient cannot phonate under general anesthesia (see our previous report 8 for detailed information).…”

Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique

“…Although we are not aware of reports measuring patient comfort levels during this procedure, our experience has been that the long sedation time can pose a challenge in certain patients, particularly those with obstructive sleep apnea and morbid obesity. Other surgeons have echoed this difficulty . In these patients and others, an adequate plane of anesthesia often is difficult to achieve in the compromise between patient comfort and the stimulation of laryngeal manipulation.…”

“…Other surgeons have echoed this difficulty. [14][15][16] In these patients and others, an adequate plane of anesthesia often is difficult to achieve in the compromise between patient comfort and the stimulation of laryngeal manipulation. The challenge in these cases is lessened when time under SA is reduced.…”