Outcomes of Arytenoid Adduction under Laryngeal Mask Mechanical Ventilation for Unilateral Vocal Fold Paralysis

Abstract

Objectives: Arytenoid adduction surgery for the unilateral vocal fold paralysis is usually carried out under intravenous sedation because improvement of the voice evaluable during surgery. In patients preferred for surgery under general anesthesia due to their physical or mental condition, we selected general anesthesia using laryngeal mask mechanical ventilation, and we confirmed the location of the vocal fold during surgery using a flexible fiberscope. To evaluate this procedure of anesthesia, we compared outcomes of the adduction surgeries between intravenous sedation and general anesthesia. Methods: From September 2012 to August 2013, adduction surgeries were performed in 17 cases under intravenous sedation with spontaneous breathing, and in 5 cases under general anesthesia using laryngeal mask. Pre- and postoperative maximum phonation time (MPT), mean flow ratio (MFR), and voice handicap index-10 (VHI-10) were evaluated. Results: MPT, MFR, and VHI-10 were remarkably improved in all adduction surgery with intravenous sedation cases. In the general anesthesia group, improvement of the factors was also recognized in most cases, but not in all. Conclusions: Adduction surgery under general anesthesia with laryngeal mechanical mask ventilation is a useful tool for the unilateral vocal fold palsy patient. However, even though we checked the position of the vocal fold in surgery, the efficacy of the surgery is not guaranteed in a few cases because the actual voice cannot be evaluated in general anesthesia.