Arytenoid adduction as an adjunct to type I thyroplasty for unilateral vocal cord paralysis

Abstract

Background. Surgical management of unilateral vocal cord paralysis has evolved over the last three decades. The recent use of type I thyroplasty has resulted in improvements in voice, swallowing, and respiration. The study was performed to evaluate our experience in 28 patients undergoing arytenoid adduction as part of their surgical rehabilitation of unilateral vocal cord paralysis.Methods. Patients undergoing arytenoid adduction with or without silastic medialization for unilateral vocal cord paralysis were entered into a prospective data base. Evaluation included symptomatic improvement in hoarseness, aspiration, dysphagia, dyspnea, and the radiographic documentation of pneumonia. Objective evaluation included mean phonatory air flow and acoustic analysis. Complications associated with surgery were recorded.Results. A satisfactory result was obtained in 27 of 28 (96%) patients. By symptom, improvement in hoarseness was evident in 96%, dyspnea 80%, dysphagia 94%, and aspiration 84%. Improvements in phonatory flow rate (p < .001), estimated mean laryngeal airway resistance (p < .001), and maximally prolonged phonation (p < .01) were identified. Complications occurred in 18% and consisted of local wound sepsis (n = 1), hematoma (n = 1), seroma (n = 1), and transient airway edema (n = 2). There were no episodes of airway obstruction requiring tracheostomy or implant extrusion.Conclusions. Arytenoid adduction as part of type I thyroplasty is a safe and effective procedure. Subjective analysis confirms marked improvement in laryngeal function in the form of speech, swallowing, and respiration. Objective analysis confirms improvement in voice parameters. Future directions will focus on determination of those patients best served by arytenoid adduction.

Glottic Closure Patterns: Type I Thyroplasty Versus Type I Thyroplasty With Arytenoid Adduction

“…This study by Kraus et al evaluated only individual data and made no comparisons between groups. 13 The other two articles found by Chester looked at AA with Th without comparing the procedures and Th alone versus AA alone. 6 Our study has limitations.…”

Aerodynamic Evaluation of the Postthyroidectomy Voice

“…Aerodynamic assessment of phonation has been used successfully to quantify vocal dysfunction in patients with unilateral vocal fold paralysis (UVFP) [4][5][6][7] or unilateral superior laryngeal nerve dysfunction. 8 It has also been used to track improvements in phonation after surgical [9][10][11][12][13] and behavioral 14 treatments. Aerodynamic variables typically include mean phonatory airflow, estimated subglottal air pressure (P sg ), and laryngeal airway resistance (R law ), which involves a calculation of the ratio of pressure to flow as air passes through the larynx.…”

“…MPT, average phonatory airflow, and R law are apparently robust measures that do not reflect 17,25,26 Studies that successfully used these measures to signify dysphonia had selected only those patients who had laryngeal signs or symptoms related to a surgical procedure, disease process, or idiopathic nature. [4][5][6][7][8][9][10][11][12][13][14] Two measures included in this study, F0 range and PTP, changed significantly across sessions but not between groups. At the first postoperative session, maximum F0 range decreased almost four STs on average for the thyroidectomy group and almost one ST in the nonneck surgery group.…”

Correlation between Functional MRI And Voice Improvement Following Type I Thyroplasty in Unilateral Vocal Fold Paralysis—A Case Study

“…6,7 Reported findings are consistent with the results obtained from the patient examined in the present study. fMRI results are likely associated with improved voice production due to restored glottic efficiency.…”

“…Type I thyroplasty, a commonly used surgical rehabilitation approach for patients with voice disorder and glottic insufficiency due to unilateral vocal fold paralysis (UVFP), is associated with improved voice and swallowing. [3][4][5][6][7] Patients undergoing this type of surgical procedure provide an opportunity to examine a central mechanism of adaptation associated with dysphonia and its remediation following surgery.…”