Arytenoid adduction with medialization laryngoplasty versus injection or medialization laryngoplasty: The role of the arytenoidopexy

Mortensen, Melissa; Carroll, Linda M.; Woo, Peak

doi:10.1002/lary.20171

Cited by 65 publications

(60 citation statements)

References 15 publications

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“…216 These are focused around improving VF approximation by improving efficiency of the weakened system with behavioral management. 225,230,245 The goal of voice therapy is to improve glottal closure without supraglottic hyperfunction by development of abdominal support for breathing and intrinsic muscle strengthening exercises. These may be effective interventions as a temporary improvement until normal voice recovers, may aid in selection of patients for surgical intervention, or may provide the essentials for long-term rehabilitation.…”

Section: Action Statement Profilementioning

confidence: 99%

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Chandrasekhar

Randolph

Seidman³

et al. 2013

Otolaryngol.--head neck surg.

351

100

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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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Section: Action Statement Profilementioning

confidence: 99%

Clinical Practice Guideline: Improving Voice Outcomes after Thyroid Surgery

Chandrasekhar

Randolph

Seidman³

et al. 2013

Otolaryngol.--head neck surg.

351

100

View full text Add to dashboard Cite

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“…Mortensen et al also looked at AA with Th versus Th alone but looked at objective outcome measures only. 4 In comparing the two groups, they found that the combined-procedure group had worse preoperative average phonatory function and that there were no significant differences in outcome postoperatively. When comparing the improvement in outcome, they did find significantly greater improvement in the combined-procedure group.…”

Section: Discussionmentioning

confidence: 96%

“…AA requires extra surgical time, and increased complication rates have been reported. 3,4 Although studies have shown that AA provides good posterior glottic closure, no study has demonstrated that it creates better closure than Th alone. 5 Studies measuring patient's perception of vocal function along with objective acoustic measures comparing Th alone with Th plus AA have not reached any definitive concensus.…”

Section: Introductionmentioning

confidence: 99%

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

Li¹,

Johns²,

Jackson-Menaldi³

et al. 2011

Journal of Voice

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“…The most common phonosurgical procedures used today are: injection augmentation, medialization thyroplasty, and arytenoid adduction (AA). 2,3 When using an external approach through the thyroid cartilage as in medialization thyroplasty, only the anterior membranous part of the vocal fold can be medialized. 4,5 To close the posterior glottis and/or correct level differences of the vocal folds, an AA can be performed together with medialization thyroplasty.…”

Section: Introductionmentioning

confidence: 99%

“…The major drawback is the difficult accessibility of the muscular process deserving a demanding surgical procedure with significant increased morbidity including hypopharyngeal perforation, postoperative respiratory distress, and tracheotomy. 3,5 To overcome these difficulties, several modifications of the AA procedure have been proposed, for example, the resection of the posterior rim of the thyroid plate or pulling on the LCA muscle through a thyroid window. 6,7 Based on our former anatomical studies it should be possible to get access to the muscular process of the arytenoid cartilage through a standard medialization thyroplasty window.…”

Section: Introductionmentioning

confidence: 99%