Control of Pre‐phonatory Glottal Shape by Intrinsic Laryngeal Muscles

Abstract

Objectives Surgical manipulations to treat glottic insufficiency aim to restore the physiologic pre‐phonatory glottal shape. However, the physiologic pre‐phonatory glottal shape as a function of interactions between all intrinsic laryngeal muscles (ILMs) has not been described. Vocal fold posture and medial surface shape were investigated across concurrent activation and interactions of thyroarytenoid (TA), cricothyroid (CT), and lateral cricoarytenoid/interarytenoid (LCA/IA) muscles. Study Design In vivo canine hemilarynx model. Methods The ILMs were stimulated across combinations of four graded levels each from low‐to‐high activation. A total of 64 distinct medial surface postures (4 TA × 4 CT × 4 LCA/IA levels) were captured using high‐speed video. Using a custom 3D interpolation algorithm, the medial surface shape was reconstructed. Results Combined activation of ILMs yielded a range of unique pre‐phonatory postures. Both LCA/IA and TA activation adducted the vocal fold but with greater contribution from TA. The transition from a convergent to a rectangular glottal shape was primarily mediated by TA muscle activation but LCA/IA and TA together resulted in a smooth rectangular glottis compared to TA alone, which caused rectangular glottis with inferomedial bulging. CT activation resulted in a lengthened but slightly abducted glottis. Conclusions TA was primarily responsible for the rectangular shape of the adducted glottis with synergistic contribution from the LCA/IA. CT contributed minimally to vocal fold medial shape but elongated the glottis. These findings further refine laryngeal posture goals in surgical correction of glottic insufficiency. Level of Evidence NA, Basic science Laryngoscope, 133:1690–1697, 2023