Adduction arytenopexy with medialization laryngoplasty and cricothyroid subluxation: A new approach to paralytic dysphonia

Abstract

Laryngoplastic phonosurgery has evolved into a dominant treatment modality for paralytic dysphonia. Current surgical procedures have primarily addressed the position of the vocal fold in the axial and vertical planes. However, dynamic range capabilities and vocal flexibility have been limited secondary to the flaccid, dennervated vocal-fold tissue. Two new procedures were designed to optimally position the arytenoid and to restore tension in the dennervated vocal fold. The new adduction arytenopexy procedure more closely models the biomechanics underlying normal cricoarytenoid adduction than the classical arytenoid adduction does. This procedure allows for gliding, rocking, and rotating of the arytenoid on the cricoid facet, thereby simulating simultaneous agonist-antagonist function of the interarytenoid, lateral cricoarytenoid, and posterior cricoarytenoid muscles. Cricothyroid subluxation (C-T sub) was designed as a technique to increase the distance between the cricoarytenoid joint and the insertion of the anterior commissure ligament. This led to an increase in length and tension of the thyroarytenoid musculature so that there is improved dynamic frequency range of the voice. C-T sub enhanced the postoperative voice of patients, regardless of whether they required medialization laryngoplasty alone or with adduction arytenopexy.