A “Fenestration Approach” for Arytenoid Adduction Through the Thyroid Ala Combined With Type I Thyroplasty

Abstract

A fenestration-based approach simplified the combination of AA and type I thyroplasty because the two treatments could be performed in the same operating field and provided good voice improvement. Pulling the AA braid in the contractile direction of the LCA and endoscopic vocal cord observation during surgery may have contributed to the positive results.

Sling arytenoid adduction

“…One of the most appealing advantages of this SAA technique is the possibility to pass a sling around the muscular process without having to dissect the thyroid cartilage (or dislocate the cricothyroid joint), for one of each is always the case in all other techniques of arytenoid adduction or arytenopexy [1,2,[4][5][6][7][8]. Furthermore, in our technique of SAA the muscular process needs no direct suturing.…”

“…The advantages of arytenoid adduction are undisputed [1][2][3][4][5][6][7][8]. In addition to medialization of the ligamentous part of the vocal folds, e.g., in vocal fold augmentation procedures, the closure of the posterior part of the glottis is an undoubted advantage for many patients with lateral vocal process position.…”

“…However, the technique of AA is not as easy as medialization thyroplasty, presumably because of the advanced invasiveness during the surgery and increase of risk for complications [2]. Even following all surgical recommendations and staying within boundaries outlined by surgical instructions, the exposure and suture of the muscular process remains challenging [3][4][5][6][7][8]. This might be a reason why beginning phonosurgeons are reluctant to perform AA operations.…”

Analysis of Pitch Range After Arytenoid Adduction by Fenestration Approach Combined With Type I Thyroplasty for Unilateral Vocal Fold Paralysis

“…However, we consider it beneficial to reproduce the physiological adduction of the arytenoid cartilage using AA to achieve a good clinical response. [8][9][10] We previously reported our approach for AA through a small window on the thyroid ala, called the fenestration approach. 9 We have achieved a 100% improvement rate with AA by the fenestration approach combined with type I thyroplasty for all UVFP cases, regardless of the grade of hoarseness or maximum phonation time (MPT).…”

“…[8][9][10] We previously reported our approach for AA through a small window on the thyroid ala, called the fenestration approach. 9 We have achieved a 100% improvement rate with AA by the fenestration approach combined with type I thyroplasty for all UVFP cases, regardless of the grade of hoarseness or maximum phonation time (MPT). 9 Postoperative patients are sometimes capable of singing at or near preoperative levels.…”