Outcomes of medialization laryngoplasty with and without arytenoid adduction

Chang, Joseph; Schneider, Sarah; Curtis, James A.; Langenstein, Jonelyn; Courey, Mark S.; Yung, Katherine C.

doi:10.1002/lary.26773

Cited by 29 publications

(27 citation statements)

References 13 publications

(31 reference statements)

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“…McCulloch et al evaluated voice outcomes in patients who underwent ML alone versus ML+AA and demonstrated greater improvement in multiple voice parameters in the ML+AA group; however, no statistical comparisons were made between the two treatment groups. 48 Although Chang et al 49 demonstrated that both ML and ML+AA resulted in improvement in overall severity voice scores based on the CAPE-V perceptual evaluation tool, the difference in overall severity was not statistically significant at any time point between the two treatment groups. 49 Our study also found that both ML and ML+AA resulted in improved overall CAPE-V scores, although difference in improvement between groups was not significant after adjusting for covariates.…”

Section: Discussionmentioning

confidence: 91%

“…Chang et al determined that the posterior gap showed improved closure only in the ML+AA group compared to ML alone. 49 Abraham et al reported that ML+AA appeared to show improved closure of the posterior glottis, with no difference in complication rates, when compared to ML alone. 28 Our study also found no significant increase in total complications, defined as postoperative hematoma, vocal fold edema, wound infection, or tracheostomy, with ML+AA compared to ML alone.…”

Section: Discussionmentioning

confidence: 99%

“…There are few studies assessing patient‐centered outcomes with respect to voice, thus making patient selection for AA difficult. Some studies have compared acoustic and aerodynamic voice outcomes following ML versus ML+AA in patients with UVFP, whereas others have evaluated glottal gap closure, all in retrospective fashion . Currently, a dearth of studies exist that elucidate preoperative patient characteristics that may be useful in predicting which patients will ultimately benefit the most from AA.…”

Section: Discussionmentioning

confidence: 99%

“…Li et al were unable to find any statistically significant difference in postoperative glottic closure between ML alone and ML+AA; however, this finding could signify that AA was necessary in patients with wider posterior glottic gaps and/or vertical height mismatches to achieve similar results to patients undergoing ML alone. Chang et al determined that the posterior gap showed improved closure only in the ML+AA group compared to ML alone . Abraham et al reported that ML+AA appeared to show improved closure of the posterior glottis, with no difference in complication rates, when compared to ML alone .…”

Section: Discussionmentioning

confidence: 99%

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Voice outcomes following medialization laryngoplasty with and without arytenoid adduction

et al. 2018

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Objective Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA). Methods Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009–2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index‐10 (VHI‐10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE‐V) were assessed. Results Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI‐10 scores (P < 0.001), and CAPE‐V scores (P = 0.007). Baseline VHI‐10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI‐10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE‐V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates. Conclusion Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA. Level of Evidence 4 Laryngoscope, 129:1876–1881, 2019

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Voice outcomes following medialization laryngoplasty with and without arytenoid adduction

et al. 2018

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“…If there is no recovery or if there is inadequate compensation after UVFP, procedures aiming to restore glottic competence include permanent and temporary vocal fold injections or laryngeal framework surgery, such as a type I medialization laryngoplasty. Relatively small glottic gaps between membranous vocal folds are generally accepted to be more appropriate for injection laryngoplasty, whereas larger glottic gaps with symptomatic posterior glottic gaps are found to be ideal for medialization laryngoplasty with or without the addition of an arytenoid adduction …”

Section: Introductionmentioning

confidence: 99%

Transoral silastic medialization for unilateral vocal fold paralysis

2019

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Background Medialization laryngoplasty has historically been performed through an external approach. The aim of our work is to demonstrate the feasibility of silastic vocal fold medialization transorally. Methods Patients with unilateral vocal fold paralysis requiring medialization laryngoplasty were included in this report. Silastic medialization was done through a transoral approach. A supraglottic laryngotomy is performed followed by dissection and tunneling in the paraglottic space. Silastic implant is inserted into the tunnel to medialize the vocal fold and the ipsilateral arytenoid. The laryngotomy is tightly closed by endoscopic sutures. Results A consecutive series of 22 patients are reported. All patients had dysphonia with significant glottic insufficiency. After endoscopic silastic medialization, voice and swallowing were significantly improved (P < .001). No postoperative complications or implant extrusion occurred in our series. Conclusion Silastic vocal fold medialization can be safely and effectively performed through a transoral approach with good results on voice and swallowing.

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An Ex‐vivo Model Examining Acoustics and Aerodynamic Effects Following Medialization With and Without Arytenoid Adduction

et al. 2022

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Objectives/Hypothesis Quantify differences in acoustics and intraglottal flow fields between Thyroplasty Type 1 (TT1) with and without arytenoid adduction (AA) using excised canine larynx model. Study Design Basic science experiments using excised larynges. Methods Surgical procedures were implemented in eight excised canine larynges. Acoustics and intraglottal flow measurements were taken at low and high subglottal pressures in each experimental setup. Results In all larynges, vocal efficiency (VE) and cepstrum peak prominence (CPP) were higher, and the mean phonatory flow rate was lower in TT1 with AA than without AA. The glottal asymmetry is reduced with AA and promotes the formation of stronger vortices in the glottal flow during the closing phase of the vibrating folds. Conclusions Findings suggest a clear acoustic and aerodynamic benefit to the addition of AA when performing TT1. It shows significant improvement in CPP, translating to decreased breathiness and dysphonia and increased VE, leading to easier and more sustainable phonation. Stronger intraglottal vortices are known to be correlated with the loudness of voice produced by phonation. Level of Evidence N/A Laryngoscope, 133:621–627, 2023

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Outcomes of medialization laryngoplasty with and without arytenoid adduction

Abstract: 4. Laryngoscope, 127:2591-2595, 2017.

Cited by 29 publications

References 13 publications

Voice outcomes following medialization laryngoplasty with and without arytenoid adduction

Voice outcomes following medialization laryngoplasty with and without arytenoid adduction

Transoral silastic medialization for unilateral vocal fold paralysis

An Ex‐vivo Model Examining Acoustics and Aerodynamic Effects Following Medialization With and Without Arytenoid Adduction

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