Arytenoid Adduction for Unilateral Vocal Cord Paralysis

Isshiki, Nobuhiko; Tanabe, Masahiro; Sawada, Masashi

doi:10.1001/archotol.1978.00790100009002

Cited by 382 publications

(250 citation statements)

References 6 publications

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“…Therefore, efforts to prevent RLN damage as well as to assess RLNP promptly are essential for the postoperative management of patients undergoing an esophagectomy. The generally accepted management methods for patients with URLNP are observation for several months after surgery, intracordal injection (Graboyes et al 2011), type I thyroplasty (Isshiki et al 1989;Schneider et al 2003), arytenoids adduction (Isshiki et al 1978), and laryngeal reinnervation. In cases with RLN involvement via metastatic nodes, the RLN is sometimes resected together with metastatic nodes to enable a curative operation (Tachimori et al 1995).…”

Section: Introductionmentioning

confidence: 99%

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

Koyanagi

Igaki

Iwabu

et al. 2015

Tohoku J. Exp. Med.

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Recurrent laryngeal nerve paralysis (RLNP) after esophagectomy is a common complication and associated with aspiration pneumonia. In this study, we assessed the risk of RLNP and the usefulness of immediate reconstruction of recurrent laryngeal nerve (RLN) to prevent respiratory complications after esophagectomy. Seven hundred and eighty-two consecutive patients underwent an esophagectomy with three-field lymph node dissection, simultaneous gastric conduit reconstruction, and cervical anastomosis. Vocal cord function was observed using a flexible laryngoscope. Reconstruction between RLN and ipsilateral vagus nerve was performed during esophagectomy. RLNP was observed in 229 (29.3%) of the patients after esophagectomy: 198 unilateral and 31 bilateral cases. Of the 198 unilateral RLNP, vocal cord paralysis was observed predominantly on the left side (82.7%). RLNP was significantly associated with postoperative respiratory complications (P < 0.001) requiring a tracheotomy (P < 0.001) and mechanical ventilation (P < 0.001) and was also associated with esophagogastric anastomotic leakage (P = 0.015); consequently, the postoperative hospital stay was longer for patients with RLNP (P < 0.001). A longer operation time (P < 0.001) and advanced age (P = 0.038) were identified as significant independent predictors of RLNP. Resection of the RLN together with metastatic nodes was performed in 29 cases. The patients underwent RLN reconstruction (n = 11) had a significantly shorter postoperative hospital stay than those without RLN reconstruction (n = 18) (P = 0.019). In conclusion, RLNP was related to a poorer postoperative course among patients undergoing an esophagectomy. New surgical technologies are recommended for prevention of RLNP.

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Section: Introductionmentioning

confidence: 99%

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

Koyanagi

Igaki

Iwabu

et al. 2015

Tohoku J. Exp. Med.

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“…225 Framework procedures refer to adjustments of VF position by manipulation of laryngeal tissue. These are performed by mobilization of the hypomobile VF toward the midline with an implant 226 (as in medialization thyroplasty) or by manipulation of the laryngeal cartilages (as in arytenoid adduction 227,228 or arytenoidpexy 229 ). These procedures can be performed in isolation or can be combined 230 and require a small neck incision that may be separate from the incision of the thyroid operation.…”

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confidence: 99%

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Chandrasekhar

Randolph

Seidman³

et al. 2013

Otolaryngol.--head neck surg.

331

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Objective. Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient's voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period.Purpose. The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well.Results. The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient's voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient's voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesi...

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“…Initially described by Isshiki et al, 3 this technique allows for the placement of a silastic implant which medializes the paralyzed vocal cord. Additional advances have been achieved by Isshiki et al 4 and Netterville 5 using arytenoid adduction. This is particularly useful in patients with large glottic gaps posteriorly where the silastic implant is ineffective in closing the posterior commissure.…”

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confidence: 99%

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

et al. 1999

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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. © 1999 John Wiley & Sons, Inc. Head Neck 21: 52–59, 1999.

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Arytenoid Adduction for Unilateral Vocal Cord Paralysis

Cited by 382 publications

References 6 publications

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

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

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