Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure

Schaefer, Steven David; Close, Lanny Garth; Brown, Orval E.

doi:10.1288/00005537-198606000-00012

Cited by 31 publications

(15 citation statements)

References 8 publications

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“…The addition of anterior capsular ligament and posterior capsular ligament ablations resulted in more cricoarytenoid joint instability with even less control over adduction and abduction, but no subluxation occurred unless other supporting structures were disconnected. This may be relevant to the surgical correction of posterior commissure stenosis without arytenoidectomy in which lysis of scar tissue at the medial cricoarytenoid joint, in the vicinity of the cricoarytenoid ligament, anterior capsular ligament, and posterior capsular ligament, is performed 41,42 …”

Section: Discussionmentioning

confidence: 99%

Three‐Dimensional Analysis of Cricoarytenoid Joint Motion

Wang

1998

The Laryngoscope

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The normal motion of the cricoarytenoid joint was characterized and analyzed in this study using seven fresh cadaver larynges mounted rigidly in an external fixator apparatus after radiopaque markers were attached to laryngeal landmarks. Fluoroscopic imaging and recording was performed of top, front, and side views while the arytenoid cartilages of each larynx were manipulated through the full range of motion from adduction to abduction. Computer video capture was performed of the recordings and editing of still frames accomplished to generate three-dimensional plots of cricoarytenoid joint motion, which are shown in the manuscript. Selective and varying sequential disconnection of muscular and ligamentous structures to the arytenoid cartilage was achieved to determine their contributions to cricoarytenoid joint motion limitations and stability. The vocalis ligament, cricoarytenoid ligament, and conus elasticus are most important in controlling abduction, whereas the posterior cricoarytenoid muscle and conus elasticus are crucial in limiting adduction. The vocalis ligament prevents posterior displacement of the vocal process, while the cricoarytenoid ligament and a newly described ligament, the posterior capsular ligament, restricts anterior vocal process migration. Another ligament, the anterior capsular ligament, is described, which limits backward arytenoid cartilage tilting and lateral movement of the arytenoid cartilage on the cricoid cartilage facet. Section of the vocalis ligament with underlying conus elasticus produced reducible lateral arytenoid cartilage subluxation. Confirmation of cricoarytenoid joint facet relationships in full adduction and abduction was accomplished by fixation of the cricoarytenoid joints of one larynx in the two positions with adhesive, and subsequent exposure of the joint surfaces. Review of literature detailing human laryngeal embryological development shows that the glottis and arytenoid cartilages are formed in adduction, which explains how cricoarytenoid joint ligaments collaborate to achieve accurate vocal process approximation in adduction despite side-to-side asymmetries of the cricoarytenoid joint structures in the same larynges.

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Section: Discussionmentioning

confidence: 99%

Three‐Dimensional Analysis of Cricoarytenoid Joint Motion

Wang

1998

The Laryngoscope

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“…The ankylosis of the cricoarytenoid joints at the adducted position did not move with any manipulation. The result was not as successful as reported in the literature 12 . Cordotomy was used over arytenoidotomy in the patient with type IV stenosis because it is simpler to perform and less time‐consuming.…”

Section: Discussionmentioning

confidence: 82%

“…However, when scar tissue involves the posterior commissure area, primary excision without coverage will not prevent the recurrence of cicatrix. Microtrapdoor flaps have been described for covering the denuded area 11,12 . In larynges with PGS, raising of any type mucosal flaps is technically challenging even with open exposure.…”

Section: Discussionmentioning

confidence: 99%

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Posterior Glottic Stenosis Mechanism and Surgical Management

et al. 1997

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Posterior glottic stenosis with arytenoid fixation is an uncommon complication of laryngeal injury. Though etiologies vary; the most common is prolonged intubation. Patients with this problem are tracheotomy dependent and have compromised voice production. There has been no acceptable approach to reconstruction of the larynx, the majority of patients being treated with some type of vocal fold lateralization. The success rate with this approach varies, and this procedure does not take advantage of the intact neuromuscular status of the larynx. Over the past 3 years we have utilized an alternative approach, to repair the stenosis and mobilize the arytenoids in 10 patients. Our surgical technique involves laryngeal exposure via a laryngofissure, the removal of posterior glottic cicatricial tissues, and the application of an autologous graft. Subsequently, all but one of the patients were able to be decannulated. Subjective postoperative voice analysis showed improved voice production. The pathophysiology for this disorder and a review of different treatment modalities are discussed.

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“…The posterior insertion zone of the vocal ligament at the vocal process is also termed the "posterior commissure" [ 18,25,28]. This nomenclature is incorrect in comparison to the term "anterior commissure" regarding the m e a n i n g of the word and morphology.…”

Section: Discussionmentioning

confidence: 99%

Functional and clinical anatomy of the posterior insertion of the human vocal ligament

Paulsen

Tillmann

1997

Eur Arch Otorhinolaryngol

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The suggested methods of the formation of intubation granuloma as well as carcinoma invasion in the area of posterior vocal ligament insertion have been controversial. One reason for divergent opinions is possibly based on different judgements of morphology in this region. The present study analyzed structures of the vocal ligament and vocalis muscle insertion at the vocal process by means of histological, immunohistochemical and electron microscopic methods. Investigations were performed in three planes on the vocal cords of 22 men and 19 women (aged 21-97 years). Inside the insertion zone of the vocal ligament at the vocal process three structures could be distinguished: hyaline cartilage at the base of arytenoid cartilage, elastic cartilage at its apex and the posterior elastic nodule in front of them. No perichondrium could be seen around the elastic nodule. In elastic nodules type I and type III collagen fibrils as well as elastic fibers formed a scissor-like meshwork around large fibroblasts. The vocalis muscle inserted at the perichondrium in the lateral part of the arytenoid skeleton by short tendons. At the insertion zone blood vessels of the vocalis muscle penetrated the perichondrium and reached the cartilaginous matrix. At the beginning of osteogenesis, the blood vessels connected with intraosseous blood vessels of the arytenoid. Connective tissue cells of the insertion zone and extracellular matrix components formed by these cells fulfilled a biomechanical function by equalizing the different elastic moduli of tendon, cartilage or bone. The lack of perichondrium around the lengthened posterior elastic nodule made formation of intubation granulomas caused by perichondritis in this area impossible. Loosened perichondrium or periosteum in the area of the insertion of the vocalis muscle at the vocal process, ossification and associated vascularization of the arytenoid skeleton permitted invasion of carcinomas into the arytenoid.

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Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure

Cited by 31 publications

References 8 publications

Three‐Dimensional Analysis of Cricoarytenoid Joint Motion

Three‐Dimensional Analysis of Cricoarytenoid Joint Motion

Posterior Glottic Stenosis Mechanism and Surgical Management

Functional and clinical anatomy of the posterior insertion of the human vocal ligament

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