Medialization Thyroplasty and Arytenoid Adduction for Management of Neurological Vocal Fold Immobility

2020 ◽  
pp. 85-97
Author(s):  
Vyas M.N. Prasad ◽  
Marc Remacle
Keyword(s):  
Vocal Fold ◽  
Arytenoid Adduction ◽  
Medialization Thyroplasty ◽  
Vocal Fold Immobility

Identifying the Prevalence of Dysphagia among Patients Diagnosed with Unilateral Vocal Fold Immobility

2018 ◽  
Vol 160 (6) ◽  
pp. 955-964 ◽  
Author(s):  
Dimin Zhou ◽  
Mohsin Jafri ◽  
Inna Husain
Keyword(s):  
Vocal Fold ◽  
Large Scale ◽  
English Language ◽  
Acute Onset ◽  
Small Sample ◽  
Population Heterogeneity ◽  
Eligibility Criteria ◽  
Medialization Thyroplasty ◽  
Vocal Fold Immobility ◽  
Online Library

Objective To identify dysphagia prevalence and characteristics among patients with unilateral vocal fold immobility (UVFI) through a systematic review of current literature. Data Sources Embase, PubMed, ScienceDirect, Wiley Online Library. Review Methods Four electronic databases were reviewed according to the PRISMA criteria. Original English-language studies examining dysphagia among adult patients with UVFI met eligibility. Two researchers independently analyzed qualified articles. Results Of 227 studies discovered through the literature search, 17 satisfied eligibility criteria. The prevalence of symptomatic dysphagia ranged from 55.6% to 69.0%, and the aspiration rate was 20.0% to 50.0%. Self-reporting and clinical evaluation were used to identify symptomatic dysphagia, while videofluoroscopic swallowing study and functional endoscopic evaluation of swallowing evaluated aspiration. Left-sided UVFI predominated. The most common causes of UVFI were iatrogenic and idiopathic. Central lesions and acute-onset UVFI were each associated with more severe dysphagia. Patients were more likely to aspirate on liquids versus purées and pastes. Benefits of medialization thyroplasty and vocal cord injection were equivocal. Conclusion A significant portion of patients with UVFI present with dysphagia due to anatomic and physiologic disruptions during the swallow. Study population heterogeneity and small sample sizes in the reviewed studies may have compromised reliability, calling for large-scale studies with rigorous methodology. Future studies should not only strive to identify the mechanics of the disordered swallow but also explore patients’ quality of life and the effectiveness of current treatments for dysphagia with underlying UVFI.

Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask

2011 ◽  
Vol 146 (2) ◽  
pp. 266-271 ◽  
Author(s):  
Nicholas W. Stow ◽  
Jennifer W. Lee ◽  
Ian E. Cole
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
Vocal Fold Paralysis ◽  
Laryngeal Mask ◽  
Unilateral Vocal Fold Paralysis ◽  
Maximum Phonation Time ◽  
Arytenoid Adduction ◽  
Medialization Thyroplasty ◽  
The Voice

Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture. Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis. Setting. Tertiary referral teaching hospital in Sydney, Australia. Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life. Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time). Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months. Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure.

Biomechanics of Arytenoid Adduction Surgery in an Ex Vivo Canine Model

1998 ◽  
Vol 107 (6) ◽  
pp. 454-461 ◽  
Author(s):  
J. Pieter Noordzij ◽  
Donald F. Perrault ◽  
Peak Woo
Keyword(s):  
Vocal Fold ◽  
Ex Vivo ◽  
Canine Model ◽  
Vocal Fold Paralysis ◽  
Lateral Movement ◽  
Arytenoid Adduction ◽  
Vocal Process ◽  
Process Procedures ◽  
Suture Tension

The biomechanics of arytenoid adduction surgery are not well understood. An excised canine larynx model was used to study the effects of variable suture tension on glottal configuration and on vocal fold tension (at the midfold and the vocal process). Arytenoid adduction both medializes the vocal fold and closes a posterior glottal chink. Vocal fold tension at the midfold did not vary significantly with suture tension. As suture tension increased to approximately 100 g, vocal fold tension at the vocal process also increased. Beyond 100 g of suture tension, vocal fold tension at the vocal process did not increase. We conclude that the effects of suture tension on the resistance to lateral movement are different at the midfold compared to the vocal process. Procedures for surgical rehabilitation of vocal fold paralysis should address the biomechanical subunits of the larynx individually in order to achieve optimum results.

Arytenoid adduction in vocal fold paralysis

1999 ◽  
Vol 10 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Frank R. Miller ◽  
Grady L. Bryant ◽  
James L. Netterville
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Arytenoid Adduction
Sign in / Sign up

Export Citation Format

Share Document