A new thread guide instrument for endoscopic arytenoid lateropexy

Abstract

Objectives/Hypothesis: The varied etiology of bilateral vocal cord immobility (BVCI) requires a wide range of surgical approaches. A new endolaryngeal thread guide instrument (ETGI) is presented here for a minimally invasive endoscopic lateropexy of the arytenoid cartilage, which might serve as a basis for a simple solution for the main types of BVCI.Study Design: Prospective study of BVCI patients who underwent surgery, including 22 bilateral vocal cord paralyses (BVCP), 12 mechanical fixations (MF), 10 posterior glottic stenoses, and two rheumatoid ankyloses.Methods: The ETGI is based on a built-in movable curved blade with a hole at its tip to guide a thread in and out again between the skin and the laryngeal cavity. The loops formed around the arytenoid cartilage cause abduction. In cases of fixations, the cricoarytenoid joints were properly mobilized as a first step with a combination of cold technique and CO 2 laser.Results: As spirometric tests proved, 32 patients achieved improved breathing ability. One temporary tracheostomy was necessary and one patient with ongoing radiotherapy could not be decannulated. Subjectively, twelve patients' voices improved or approximated normal quality due to complete vocal cord recoveries on at least one side after lateropexy was ceased. Incomplete recovery with more or less impaired voice was observed in 16 cases. Three MF patients and two BVCP patients with poor overall health condition had severe dysphonia. Conclusions:Combined with simple and readily available methods, endoscopic arytenoid lateropexy is an effective solution for BVCIs with various etiologies. The ETGI facilitates this procedure with rapid and safe creation of fixating loops at the proper position.

A comparison between transoral glottis‐widening techniques for bilateral vocal fold immobility

“…Additionally, studies in the last decades have revealed that vocal cord paralysis is not a static condition. Possible residual motion due to additional or residual innervation, reinnervation, and synkinesis might influence the postoperative voice, especially in larynges with otherwise intact structures.…”

“…9 Additionally, studies in the last decades have revealed that vocal cord paralysis is not a static condition. Possible residual motion 10,11 due to additional or residual innervation, 12 From the Department of Otorhinolaryngology-Head and Neck Surgery (L.S., B A cadaver study has been designed to provide an objective answer to these questions 14,15 by applying these methods to the anticipated breathing and phonatory characteristics of the basic endoscopic glottisenlarging procedures designed for BVCI.…”

Comparison of endoscopic techniques designed for posterior glottic stenosis—A cadaver morphometric study

“…However, by open techniques these results could be improved to 100%, but tracheostomy might have to be sustained for weeks, and many of these patients had to face a significant deterioration of laryngeal function and voice. By contrast, in our earlier studies we presented a consecutive series of 42 patients with different grades of stenosis. All were treated successfully by a minimally invasive endoscopic method following the resection of fixating scar, and mobilization of the cricoarytenoid joints and a temporary endoscopic bilateral arytenoid lateropexy.…”

Rotational thyrotracheopexy after cricoidectomy for low‐grade laryngeal chrondrosarcoma

“…In cases of total cricoidectomy, the lack of the muscles attached to the arytenoid cartilages caused the prolapse of the interarytenoid mucosa and the passive adduction of the vocal folds after removing the soft stent. Therefore, a second operation was performed involving a unilateral (case 4) or bilateral (cases 1, 2) arytenoid lateropexy with a special endolaryngeal thread guide instrument (ETGI; Mega Kft, Szeged, Hungary) . In the same surgery (cases 2, 4), the edema of the supraglottic soft tissue and interarytenoid mucosa was reduced by Ultra Dream Pulse (UDP) CO 2 laser (DS‐40U, Daeshin Enterprise, Seoul, Korea).…”