Partial Arytenoidectomy Research Articles

Transoral Robotic Posterior Glottic Scar Lysis and Partial Arytenoidectomy: Report of a Novel Application of TORS for Benign Glottic Surgery.

Transoral robotic surgery (TORS) for benign glottic conditions is scarcely represented in the literature. We aimed in this study to report on the technical feasibility of an explicitly transoral robotic approach for a patient with posterior glottic stenosis, and to highlight extant limitations in exposure and robotic instrumentation of the glottis. Retrospective chart review of a single patient undergoing a TORS approach to maximize the posterior glottic aperture. A 42-year-old female patient with posterior glottic stenosis and a tracheotomy was consented for a robotic posterior glottic scar lysis, KTP-laser assisted partial arytenoidectomy, balloon dilation, and steroid injection. The da Vinci Intuitive Surgical single-port robotic platform was used with 2 robotic arms (needle driver and scissors), and an FK-WO transoral retractor with a straight tongue blade was deployed to facilitate endolaryngeal exposure. KTP laser fiber was passed through a robotic, semi-flexible drop-in guide, and manipulated with the needle driver. Case duration was 40 minutes. There were no perioperative or immediate post-operative complications noted on short-term follow-up. We demonstrate technical feasibility and equipoise between an explicitly robotic approach and a standard endoscopic approach to posterior glottic stenosis, a common glottic condition. Further technological development and adaptation of surgical technique are necessary to advance benign robotic laryngeal surgery.

Study on the efficacy of posterior cordotomy with partial arytenoidectomy in bilateral vocal fold paralysis

Objective:The aim of this study is to investigate the efficacy of posterior cordotomy with partial arytenoidectomy in bilateral vocal fold paralysis（BVFP）. Methods:Medical records of 37 patients with BVFP were retrospectively collected, and they were all admitted to the Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, from Jan. 2019 to Dec. 2023. Preoperative and postoperative evaluations of respiratory function, voice quality, and swallowing function were conducted. Results:Postoperatively, 32 out of 37 patients achieved significant relief in breathing difficulties. Out of 29 patients with tracheostomy, 26（89.7%） were successfully decannulated. One month postoperative follow-up revealed a decline in voice quality for 33 patients（89.2%）, and 5 cases（13.5%） reported a decrease in swallowing function. However, by three months postoperatively, both voice quality and swallowing function showed significant improvement. Conclusion:Posterior cordotomy with partial arytenoidectomy is an effective surgical method for BVFP, and significantly improve respiratory difficulty despite its impact on voice quality, with no significant impairment to swallowing function, shows significant clinical value.

Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO2 LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience.

Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality.

Evaluating the Potential of AI Chatbots in Treatment Decision-making for Acquired Bilateral Vocal Fold Paralysis in Adults

ObjectivesThe development of artificial intelligence-powered language models, such as Chatbot Generative Pre-trained Transformer (ChatGPT) or Large Language Model Meta AI (Llama), is emerging in medicine. Patients and practitioners have full access to chatbots that may provide medical information. The aim of this study was to explore the performance and accuracy of ChatGPT and Llama in treatment decision making for bilateral vocal fold paralysis (BVFP). MethodsData of twenty clinical cases, treated between 2018-2023, were retrospectively collected from four tertiary laryngology centres in Europe. The cases were defined as the most common or most challenging scenarios regarding BVFP treatment. The treatment proposals were discussed in their local multidisciplinary teams (MDT). Each case was presented to ChatGPT-4.0 and Llama Chat-2.0, and potential treatment strategies were requested. The Artificial Intelligence Performance Instrument (AIPI) treatment sub score was used to compare both Chatbots’ performances to MDT treatment proposal. ResultsMost common aetiology of BVFP was thyroid surgery. A form of partial arytenoidectomy with or without posterior transverse cordotomy was the MDT proposal for most cases. The accuracy of both Chatbots was very low regarding their treatment proposals, with a maximum AIPI treatment score in 5% of the cases. In most cases even harmful assertions were made, including the suggestion of vocal fold medialisation to treat patients with stridor and dyspnoea. ChatGPT-4.0 performed significantly better in suggesting the correct treatment as part of the treatment proposal (50%) compared to Llama Chat-2.0 (15%). ConclusionChatGPT and Llama are judged as inaccurate in proposing correct treatment for BVFP. ChatGPT significantly outperformed Llama. Treatment decision-making for a complex condition such as BVFP is clearly beyond the Chatbot’s knowledge expertise. This study highlights the complexity and heterogeneity of BVFP treatment, and the need for further guidelines dedicated to the management of BVFP.

Management of Pediatric Bilateral Vocal Fold Paralysis: A State-of-the-Art Review of Etiologies, Diagnosis, and Treatments.

This paper reviews the current literature about epidemiology, etiologies, diagnosis, and management of pediatric bilateral vocal fold paralysis (PBVFP). According to PRISMA statements, a narrative review of the current literature was conducted through the PubMed, Scopus, and Cochrane Library databases about the epidemiology, etiologies, diagnosis, and management of PBVFP. PBVCP is the second most common congenital laryngeal anomaly in the pediatric population, accounting for 10% to 20% of pediatric laryngeal conditions. PBVCP is related to idiopathic (42.2%), congenital (19.7%), and neurological (16.9%) conditions. A tracheotomy is required in 60% of cases regarding stridor and dyspnea, which are the most prevalent symptoms. The diagnosis is based on the etiological features, clinical presentation, laryngoscopic findings, and objective examinations. Laryngeal electromyography may be used to support the diagnosis in difficult cases, but its reliability depends on the practitioner's experience. The primary differential diagnosis is posterior glottis stenosis, which needs to be excluded regarding therapeutic and management differences with PBVCP. Transient surgical procedures consist of tracheotomy or laterofixation of the vocal fold. Current permanent procedures include uni- or bilateral partial arytenoidectomy, posterior transverse cordotomy, cricoid splits, and laryngeal selective reinnervation. There is no evidence of the superiority of some procedures over others. PBVCP is the second most common laryngeal disorder in the pediatric population. Diagnosis is based on etiological and clinical findings and may require the use of laryngeal electromyography. Therapeutic management may involve several transient or permanent surgical procedures that are associated with overall subjective improvements in symptoms, laryngeal findings, and low complication rates.

Minimizing Thermal Damage During Thulium Laser-Assisted Partial Arytenoidectomy: Pulsed Versus Continuous Cutting in an Ex-Vivo Calf Model.

The 2 µm-wavelength thulium laser is an effective cutter during partial arytenoidectomy, but thermal trauma can damage adjacent laryngeal tissue. Pulsing laser energy may reduce trauma when compared to continuous-wave cutting. This study measured temperature changes, thermal trauma, and time to complete partial arytenoidectomy, with and without pulsing, in an ex-vivo calf model. Tissue temperature and time to complete a trans-cartilaginous cut were measured during partial arytenoidectomy on ex-vivo calf vocal folds (N = 24) using a thulium laser in continuous-wave (CW, N = 12) and pulsed-wave (PW, N = 12) modes. Energy was 5 W for CW and PW cuts; pulse-widths were 250, 500, and 750 ms. Thermal damage was analyzed histologically by measuring the depth of lactate dehydrogenase (LDH) inactivation perpendicular to the laser-cut edge at the vocal process. Paired t-tests compared CW and PW modes. Change in temperature was lower using CW (6.5°C) compared to PW modes (250 ms = 18°; 500 ms = 16°; 750 = 19°; P < .05). Trans-cartilaginous cuts were completed faster using CW (37 seconds) compared to PW (250 ms = 136 seconds; 500 ms = 61 seconds; 750 = 44 seconds; P < .05), and both modes delivered the same total Joules. The average depth of LDH depletion (thermal damage) was similar for all cuts. 1. Thulium laser cuts in continuous-mode unexpectedly produced less tissue heating yet created similar thermal damage than pulsed-mode cuts during simulated partial arytenoidectomy. 2. Trans-cartilaginous cuts were completed significantly faster in continuous-mode as compared to pulsed-mode cutting. 3. Pulsing the thulium laser does not minimize thermal damage compared to continuous wave cutting during thulium laser-assisted partial arytenoidectomy.

Computational fluid dynamic analysis of upper airway procedures in equine larynges.

Computational fluid dynamics (CFD) has proven useful in the planning of upper airway surgery in humans, where it is used to anticipate the influence of the surgical procedures on post-operative airflow. This technology has only been reported twice in an equine model, with a limited scope of airflow mechanics situations examined. The reported study sought to widen this application to the variety of procedures used to treat equine recurrent laryngeal neuropathy (RLN). The first objective of this study was to generate a CFD model of an ex-vivo box model of ten different equine larynges replicating RLN and four therapeutic surgeries to compare the calculated impedance between these procedures for each larynx. The second objective was to determine the accuracy between a CFD model and measured airflow characteristics in equine larynges. The last objective was to explore the anatomic distribution of changes in pressure, velocity, and turbulent kinetic energy associated with the disease (RLN) and each surgical procedure performed. Ten equine cadaveric larynges underwent inhalation airflow testing in an instrumented box while undergoing a concurrent computed tomographic (CT) exam. The pressure upstream and downstream (outlet) were measured simultaneously. CT image segmentation was performed to generate stereolithography files, which underwent CFD analysis using the experimentally measured outlet pressure. The ranked procedural order and calculated laryngeal impedance were compared to the experimentally obtained values. The CFD model agreed with the measured results in predicting the procedure resulting in the lowest post-operative impedance in 9/10 larynges. Numerically, the CFD calculated laryngeal impedance was approximately 0.7 times that of the measured calculation. Low pressure and high velocity were observed around regions of tissue protrusion within the lumen of the larynx. RLN, the corniculectomy and partial arytenoidectomy surgical procedures exhibited low pressure troughs and high velocity peaks compared to the laryngoplasty and combined laryngoplasty/corniculectomy procedures. CFD modeling of the equine larynx reliably calculated the lowest impedance of the different surgical procedures. Future development of the CFD technique to this application may improve numerical accuracy and is recommended prior to consideration for use in patients.

Place of Partial Arytenoidectomy in the Management of Bilateral Vocal Cord Immobilitis

Place of Partial Arytenoidectomy in the Management of Bilateral Vocal Cord Immobilitis

Initial Outcomes of Endoscopic CO2 Laser Posterior Cordectomy and Partial Arytenoidectomy Among Patients with Bilateral Vocal Cord Paralysis: A Case Series

&#x0D; &#x0D; &#x0D; &#x0D; ABSTRACTObjective: To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Methods: &#x0D; Design: Case Series&#x0D; Setting: Tertiary National University Hospital&#x0D; Participants: 17 Patients&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Results: Seventeen (17) patients who underwent transoral posterior cordectomy and partial arytenoidectomy using carbon dioxide laser were included in the study consisting of 14 females and 3 males. Iatrogenic injury was the most common cause of bilateral vocal cord paralysis in this subset of patients. Five patients who tolerated decannulation and another six who had no preoperative tracheostomy all reported subjective improvement in breathing. All of them were also observed to have resolution of stridor and increased respiratory comfort compared to their preoperative condition. The most common postoperative complication was granuloma formation at the medial arytenoidectomy site occurring only in 4 patients. None of the patients complained of aspiration episodes or dysphagia during the postoperative period.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Conclusion: Our initial experience with transoral endoscopic posterior cordectomy and partial arytenoidectomy using carbon dioxide laser has good postoperative outcomes among patients with bilateral vocal cord paralysis.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Posterior cordotomy in bilateral vocal cord paralysis

Introduction: Bilateral vocal cords paralysis in adduction when it is irreversible requires treatment due to the inspiratory dyspnea that produces. Different surgical techniques can be used to increase the glottic space. Posterior cordotomy with partial arytenoidectomy improves dyspnea and is one of the most used surgeries. Objectives: To determine the resolution rate of inspiratory dyspnea or decannulation, in patients with bilateral vocal cord paralysis in adduction treated with posterior cordotomy and partial arytenoidectomy Methods: A retrospective and descriptive study was carried out by analyzing the electronic medical records of all patients who had bilateral vocal cords paralysis in adduction and were treated with posterior cordotomy and partial arytenoidectomy between March 2004 and December 2018. The result of the posterior cordotomy with partial arytenoidectomy was determined according to the decannulation rate of the patients who had tracheostomy, according to dyspnea resolution after the cordotomy and by the increase of the postoperative glottic space evidenced by endoscopy. Results: Nineteen patients were treated by bilateral vocal cord paralysis in adduction. The most frequent cause was a total thyroidectomy (9/19). Eight had a tracheostomy prior to posterior cordotomy. Seven of eight patients who had tracheostomy were able to decannulate, the rest had insufficient glottic space and did not return to control. All patients without tracheostomy (11/19) improved their inspiratory dyspnea and had no limitation for their daily life activities. Conclusions: The resolution of inspiratory dyspnea in patients with bilateral vocal cords paralysis in adduction without tracheostomy, treated with posterior cordotomy and partial arytenoidectomy was 100% (11/11). In tracheotomized patients the decannulation rate was 87,50% (7/8).

Computed tomographic geometrical analysis of surgical treatments for equine recurrent laryngeal neuropathy.

To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions. Secondly, to use fluid mechanic principles of flow through a constriction to establish the relationship between measured airflow geometries with impedance for each surgical procedure. 10 cadaveric horse larynges. While CT scans were performed, inhalation during exercise conditions was replicated for each of the following 5 conditions: laryngeal hemiplegia, left laryngoplasty with ventriculocordectomy, left laryngoplasty with ipsilateral ventriculocordectomy and arytenoid corniculectomy, corniculectomy, and partial arytenoidectomy for each larynx while CT scans were performed. Laryngeal impedance was calculated, and selected cross-sectional areas were measured along each larynx for each test. Measured areas and constriction characteristics were analyzed with respect to impedance using a multilevel, mixed-effects model. Incident angle, entrance coefficient, outlet coefficient, friction coefficient, orifice thickness, and surgical procedure were significantly associated with upper airway impedance in the bivariable model. The multivariate model showed a significant influence of incident angle, entrance coefficient, and surgical procedure on impedance; however, the orifice thickness became nonsignificant within the model. Laryngeal impedance was significantly associated with the entrance configuration for each procedure. This suggested that the equine upper airway, despite having a highly complex geometry, adheres to fluid dynamic principles applying to constrictions within pipe flow. These underlying flow characteristics may explain the clinical outcomes observed in some patients, and lead to areas of improvement in the treatment of obstructive upper airway disease in horses.

Endoscopic coblation-assisted and partial arytenoidectomy for infants with idiopathic bilateral vocal cord paralysis.

To review our experience with endoscopic coblation-assisted and partial arytenoidectomy (ECPA) in treating idiopathic bilateral vocal cord paralysis (BVCP).A retrospective analysis of thirty-three infants (19 boys and 14 girls, aged 1–10 months) with idiopathic BVCP undergoing ECPA was performed. The therapeutic process and outcomes (surgical success, swallowing function, and voice) were reviewed. The follow-up period was >33 months.Among the thirty-three infants with idiopathic BVCP, surgery was successful in twenty-nine cases but failed in four cases. Twenty-one, nine, and three patients underwent right, left, and bilateral ECPA, with surgical success rates of 90.5%, 100.0%, and 33.3%, respectively. In addition, four and six cases were combined with subglottic stenosis (SGS) and laryngomalacia, respectively. The surgical success rates of BVCP alone and BVCP+ other airway abnormalities were 95.6% and 70.0%, respectively. During the follow-up, five infants had slight difficulty swallowing, 12 infants had partial or complete recovery movement of at least one vocal cord with satisfactory voice outcome, and five infants had early granuloma formation, which disappeared spontaneously.ECPA appears to be a promising alternative to tracheostomy and initial management in infants with idiopathic BVCP who are free of other airway abnormalities.

Partial arytenoidectomy with transoral vocal fold lateralisation in treating airway obstruction secondary to bilateral vocal fold immobility.

To report the outcome of 18 patients with a tracheostomy secondary to bilateral vocal fold immobility, who were managed using reconstructive transoral laser microsurgical techniques. A retrospective review was conducted of the surgical outcome of 18 patients with bilateral vocal fold immobility and a tracheostomy resulting from different aetiologies. Follow-up duration ranged from one to five years. A total of 18 patients had a tracheostomy at presentation because of bilateral true vocal fold immobility and stridor. All cases were treated using reconstructive transoral laser microsurgery with arytenoidectomy and vocal fold lateralisation. All patients were successfully decannulated by eight weeks after surgery. Reconstructive transoral laser microsurgery using partial arytenoidectomy with vocal fold lateralisation is minimally invasive, feasible, safe and effective for airway reconstruction in patients who present with stridor due to bilateral true vocal fold immobility.

Partial Arytenoidectomy with transoral Vocal Fold Lateralization in Treating Airway Obstruction Secondary to Bilateral Vocal Fold Immobility.

Partial Arytenoidectomy with transoral Vocal Fold Lateralization in Treating Airway Obstruction Secondary to Bilateral Vocal Fold Immobility.

Quality of life after transoral CO2 laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis

ObjectivesBilateral adductor vocal cord paralysis (BAVCP) is a rare and challenging condition whose main consequence is reduction of airway patency at the glottic level, often causing respiratory distress, while vocal function tends to remain almost normal. We investigated the effect of transoral glottal widening on quality of life and decannulation rates in patients affected by BAVCP.MethodsWe retrospectively evaluated patients affected by BAVCP and treated by transoral CO2 posterior cordotomy with or without medial partial arytenoidectomy (PC ± MPA) at two referral centers. The primary outcome was change in quality of life, evaluated pre- and post-operatively by the ADVS, VHI-30, and EAT-10 questionnaires. Secondary outcomes were the need for retreatments and, for patients with tracheotomy, the time to decannulation.ResultsThirty-three patients met selection criteria. The etiology was post-surgical in 27 cases (81.8%), idiopathic in 4 (12.1%), a trauma-related in 1 (6.0%), and to other causes in 1 (3.0%). In 22 cases (66.7%), PC was combined with MPA. A significant improvement in responses for the ADVS (p < .0001) and EAT-10 (p < .0001) was observed, whereas the VHI-30 score did not change significantly post-operatively. All nine patients with a tracheostomy were successfully decannulated within 18 months after the surgical procedure.ConclusionsFor patients affected by BAVCP, PC ± MPA by transoral CO2 laser microsurgery is a safe, customizable and minimally invasive treatment that can guarantee an affordable balance between quality of life in terms of phonation and swallowing and acceptable airway patency.

Effects of Superomedial Partial Arytenoidectomy on Incomplete Posterior Glottal Closure Caused by Arytenoid Positional Asymmetry in Excised Human Larynges

ObjectivesTo analyze the effects that arytenoid positional asymmetry has on posterior glottic closure and to determine whether superomedial partial arytenoidectomy (SPA) can provide a benefit in cases of such asymmetry. MethodsIn this experimental study, we evaluated posterior glottic closure in 10 larynges freshly excised from human cadavers, measuring the distance between the vocal processes before and after artificially simulated positional asymmetry of the arytenoid cartilages. We then performed SPA, after which we again measured the distance between the vocal processes. ResultsIn all of the larynges studied, the posterior glottic closure went from complete to incomplete after simulation of arytenoid positional asymmetry, the median distance observed between the vocal processes being 1.74mm (interquartile range 0.22). The SPA performed after arytenoid asymmetry caused the posterior glottic closure to return from incomplete to complete in all of the larynges studied. ConclusionOur results suggest that arytenoid positional asymmetry impairs posterior glottic closure and that SPA improves posterior glottic closure in such cases of arytenoid asymmetry.

Surgical Management of Bilateral Abductor Palsy: Comparative Study Between Posterior Cordotomy and Partial Arytenoidectomy.

The aim of this study is to analyse outcome of patients with bilateral abductor palsy undergoing unilateral partial arytenoidectomy and unilateral posterior cordotomy in terms of respiration, phonation and risk of aspiration. Initially tracheostomy was only treatment available to relieve respiratory distress. Now various methods are described e.g. endoscopic posterior cordotomy, arytenoidectomy, suture lateralization of vocal cords, laryngeal reinnervation and muscle transfer procedures. In our study, review of management of 21 cases of bilateral abductor palsy were carried out. Patient assessment included fibre optic laryngoscopy and radiology. Unilateral partial arytenoidectomy was carried out in 9 patients and unilateral posterior cordotomy was carried out in 12 patients. All the 21 cases in our study were tracheotomised. Among the 21 surgically treated patients 90.5% patients were decannulated. The mean increase in VHI 10 score after surgery was of 4.8. The mean increase was 4 in the partial arytenoidectomy group, whereas the mean increase in the posterior cordotomy group was 5. There was no history of aspiration following surgery. The percentage of cases requiring revision surgery was 33% in patients undergoing partial arytenoidectomy and was 25% in patients undergoing posterior cordotomy. Analysis of results after 12 months revealed that both unilateral posterior cordotomy and unilateral partial arytenoidectomy are effective and satisfactory procedures in treatment of bilateral abductor palsy.

Management of bilateral abductor paralysis: posterior cordectomy with partial arytenoidectomy using diode laser.

This study aims to assess the role of diode laser-assisted posterior cordectomy with partial arytenoidectomy in the management of bilateral vocal fold paralysis patients. Posterior cordectomy with partial arytenoidectomy using diode laser was performed to thirty-nine patients with bilateral vocal fold paralysis. Voice was evaluated by maximal phonation time and Arabic version of the voice handicap index, while breathing difficulty was assessed by mMRC (Modified Medical Research Council) dyspnea scale. There is a statistically significant decrease in mMRC from 2.8 ± 0.645 preoperatively to 0.84 ± 0.554 postoperatively (p < 0.001). However, maximum phonation time is significantly decreased from 8.04 ± 0.978 preoperatively to 6.92 ± 0.997 postoperatively (p < 0.001); there is a statistically non-significant increase in vocal handicap index from 37.12 ± 6.26 preoperatively to 37.24 ± 6.22) postoperatively (p > 0.05). The diode laser is a viable method that should be considered for the management of bilateral vocal cord paralysis. It seems to be a very promising laser device, so we expect that new diode laser wavelengths (980nm) will continue to emerge, making it a good alternative to the CO2 laser, but with lower cost, accurate manipulation, portability, shorter duration, and simplicity of use. 4.

Clinical and Pathological Features in Horses With Advanced Arytenoid Chondritis.

Equine arytenoid chondritis causes airway obstruction and abnormal upper airway noise due to a space-occupying lesion(s) and decreased abduction. Our objective was to compare clinical scores and ultrasonographic findings with gross and microscopic lesions of naturally occurring arytenoid chondritis, in order to guide surgical treatment. Seventeen naturally affected horses with advanced/severe chronic arytenoid chondritis and 4 control arytenoid cartilages were evaluated after partial arytenoidectomy. Cartilages were sectioned caudal to the corniculate process and the body of each arytenoid was measured. We assessed total gross area (TA), percentage of viable cartilage (VC), percentage of viable cartilage on the lateral wall, and medial expansion. Retrospectively, the gross lesions were used to suggest 2 preferred surgical management (SM) groups: those requiring partial arytenoidectomy and those amendable to focal medial resection (a conservative SM). TA of horses with arytenoid chondritis was significantly larger than controls (P = .005), due to a layered lesion composed of cavitation, granulation tissue, fibrosis, inflammation, hemorrhage, and edema, with relatively equal medial and lateral expansion that distorted the geometry of the affected cartilage. The increased TA paralleled the presence of immature cartilage with disorganized primitive mesenchymal cells. TA and SM were positively correlated (P = .01). All cases showed varying degrees of cartilage degeneration or necrosis, more severe medially; those appearing amenable to focal medial resection arytenoid group had significantly more viable cartilage on the lateral wall (P = .02). The gross and histopathologic findings suggest a new surgical approach-focal medial resection-that may save the lateral wall of the arytenoid.

Superomedial partial arytenoidectomy for voice improvement by correction of posterior glottic insufficiency

PurposeArytenoid resection is a well-known intervention to improve glottic airway. Superomedial partial arytenoidectomy (SPA) can also be used for voice improvement by correcting posterior glottic insufficiency in patients with an obstructing anteromedially prolapsed arytenoid. Posterior glottic insufficiency can be difficult to address and traditionally involves challenging arytenoid repositioning procedures. This study aimed to compare postoperative functional voice outcomes in patients who underwent SPA to pre-operative voice status. Second, consequences of concomitant injection augmentation in patients who underwent SPA were studied. Additionally, presenting the surgical technique.MethodsIn this retrospective cohort study, pre-operative and postoperative clinical data of patients who underwent SPA between 2004 and 2018 were analyzed. Both short- and long-term voice outcomes were assessed using Voice Handicap Index (VHI) and maximum phonation time (MPT). Pre- to postoperative assessment changes (delta: δ) were applied to multivariate analyses.ResultsA total of 105 patients were included, of which 91 had hemilaryngeal immobility, 25 had undergone previous phonosurgical procedures and 45 received concomitant injection augmentation. Patients who underwent SPA had significant improvement of VHI and MPT. In 81% of our population, laryngeal framework surgery was avoided. Multivariate analyses showed significantly improved short-term voice outcomes in patients who received injection augmentation concomitantly to SPA. Finally, δMPT was a significant predicting factor regarding additional procedures in patients who underwent SPA.ConclusionSPA is a safe and efficient procedure for voice improvement in patients with posterior glottic insufficiency due to an obstructing anteromedially prolapsed arytenoid. We recommend performing this procedure combined with injection augmentation.