Hostname: page-component-77c89778f8-cnmwb Total loading time: 0 Render date: 2024-07-18T07:20:09.588Z Has data issue: false hasContentIssue false
  • English
  • Français

Arytenoid asymmetry: Is it the most predictive parameter for arytenoid adduction in unilateral vocal fold paralysis?

Published online by Cambridge University Press:  17 February 2021

J R Menon ,
A S Mathew  and
S Nath
J R Menon
Affiliation:
Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, India
A S Mathew*
Affiliation:
Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, India
S Nath
Affiliation:
Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, India
*
Author for correspondence: Dr Amrita Suzanne Mathew, Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Medical College Kumarapuram Road, Trivandrum695011, Kerala, India E-mail: amritasmathew@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The aim of this study was to establish arytenoid asymmetry as a pre-operative predictive parameter for arytenoid adduction surgery in unilateral vocal fold paralysis and thereafter identify the most predictive parameter for arytenoid adduction among the established parameters.

Methods

A retrospective comparative study was undertaken. The ‘arytenoid asymmetry angle’ formed between skewed ‘glottic’ and ‘interarytenoid’ axes (traced along the plane of closure of the membranous and cartilaginous glottis, respectively) was quantified in pre-operative laryngoscopic images of 85 adults with unilateral vocal fold paralysis who underwent either type 1 thyroplasty (group 1) or type 1 thyroplasty with arytenoid adduction (group 2). The need for arytenoid adduction was determined intra-operatively based on subjective voice improvement and laryngoscopic results.

Results

Arytenoid asymmetry (p < 0.0001), posterior phonatory gap (p = 0.001) and vertical level difference (p = 0.004) were significantly greater in group 2 (descending order of parameters). Arytenoid asymmetry angle showed a significant positive correlation with the latter two parameters.

Conclusion

Arytenoid asymmetry is the most predictive parameter for arytenoid adduction. An arytenoid asymmetry angle of more than or equal to 33.9⁰ is an indication for arytenoid adduction. This aids in pre-operative planning of arytenoid adduction.

Keywords

Arytenoid CartilageLaryngeal MusclesVocal Cord ParalysisLaryngoplastyLaryngoscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 2 , February 2021 , pp. 159 - 167
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr A S Mathew takes responsibility for the integrity of the content of the paper

Presented at Phonocon, the Annual Meeting of the Association of Phonosurgeons of India, 29 February 2020, Daman, India.

References

Letson, JA, Tatchell, R. Arytenoid movement. In: Sataloff, RT, ed. Professional voice: The Science and Art of Clinical Care III, 3rd edn. San Diego: Plural Publishing, 2005;9:179–92Google Scholar
Nerurkar, NK, Menon, J. Arytenoid adduction. In: Mohan, S, Young, K, Judd, O, eds. A Practical Guide to Laryngeal Framework Surgery. Braunton: Compton Publishing Limited, 2017;8:95–105Google Scholar
Netterville, JL, Billante, CR. The immobile vocal cord. In: Ossoff, RH, Shapshay, SM, Woodson, GE, Netterville, JL, eds. The Larynx. Philadelphia: Lippincott Williams & Wilkins, 2003;269–302Google Scholar
Simpson, BC, Cheung, EJ. Evaluation of vocal fold paralysis. In: Sulica, L, Blitzer, A, eds. Vocal Fold Paralysis. New York: Springer Verlag Berlin Heidelberg, 2006;55–61CrossRefGoogle Scholar
Bielamowicz, S, Berke, GS, Gerratt, BR. A comparison of type 1 thyroplasty and arytenoid adduction. J Voice 1995;9:466–72CrossRefGoogle Scholar
Blitzer, A, Zeitels, SM, Netterville, JL, Meyer, TK, Smith, ME. Vocal fold medialization, arytenoid adduction and reinnervation. In: Blitzer, A, Brin, MF, Ramig, O, eds. Neurological Disorders of the Larynx. New York: Thieme, 2011;15:127–47Google Scholar
Rubinstein, BJ, Courey, MS. Decision-making in arytenoid adduction. In: Amin, MR, Johns, MM, eds. Decision Making in Vocal Fold Paralysis. Cham: Springer, 2019;97–114CrossRefGoogle Scholar
Isshiki, N, Tanabe, M, Sawada, M. Arytenoid adduction for unilateral vocal cord paralysis. Arch Otolaryngol 1978;104:555–8CrossRefGoogle ScholarPubMed
Daniero, JJ, Garrett, CG, Francis, DO. Framework surgery for treatment of unilateral vocal fold paralysis. Curr Otorhinolaryngol Rep 2014;2:119–30CrossRefGoogle ScholarPubMed
Woo, P. Arytenoid adduction and medialization laryngoplasty. Otolaryngol Clin North Am 2000;33:817–39CrossRefGoogle ScholarPubMed
Wong, E, Smith, M, Stone, DB, Palme, CE, Smith, MC, Riffat, F. Arytenoid vertical height discrepancy in predicting outcomes after unilateral vocal cord medialization. Laryngoscope 2020;130:418–22CrossRefGoogle ScholarPubMed
McCulloch, TM, Hoffman, HT, Andrews, BT, Karnell, MP. Arytenoid adduction combined with Gore-Tex medialization thyroplasty. Laryngoscope 2000;110:1306–11CrossRefGoogle ScholarPubMed
Chhetri, DK, Gerratt, BR, Kreiman, J, Berke, GS. Combined arytenoid adduction and laryngeal reinnervation in the treatment of vocal fold paralysis. Laryngoscope 1999;109:1928–36CrossRefGoogle ScholarPubMed
Rosen, CA. Complications of phonosurgery: results of a national survey. Laryngoscope 1998;108:1697–1703CrossRefGoogle ScholarPubMed
Simpson, BC, Cheung, EJ. Evaluation of vocal fold paralysis. In: Sulica, L, Blitzer, A, eds. Vocal Fold Paralysis. New York: Springer Verlag Berlin Heidelberg, 2006;4:55–61CrossRefGoogle Scholar
Isshiki, N. Phonosurgery.Theory and Practice. Tokyo: Springer Verlag Tokyo, 1989;62–7CrossRefGoogle Scholar
Nemr, K, Simoes-Zenari, M, Cordeiro, GF, Tsuji, D, Ogawa, AI, Ubrig, MT et al. GRBAS and Cape-V scales: high reliability and consensus when applied at different times. J Voice 2012;26:812–17CrossRefGoogle ScholarPubMed
Lau, J, Loizou, P, Palme, C, Riffat, F. The suspended endoscopy technique (SET) for intra-operative assessment in awake type I thyroplasty—how I do it. Australian Journal of Otolaryngology 2018;1:1–5CrossRefGoogle Scholar
Woodson, GE, Murry, T. Glottic configuration after arytenoid adduction. Laryngoscope 1994;104:965–9CrossRefGoogle ScholarPubMed
Phaniendrakumar, V, Reddy, SR, Das, MH. Medialization laryngoplasty with silastic implant for unilateral vocal cord paralysis. Indian J Otolaryngol Head Neck Surg 1997;49:262–4Google Scholar
Lindestad, PA, Hertegård, S, Björck, G. Laryngeal adduction asymmetries in normal speaking subjects. Logoped Phoniatr Vocol 2004;29:128–34CrossRefGoogle ScholarPubMed
Woodson, GE. Arytenoid repositioning surgery. In: Sulica, L, Blitzer, A, eds. Vocal Fold Paralysis. New York: Springer Verlag Berlin Heidelberg, 2006;10:176–84Google Scholar
Wong, EH, Smith, M, Tjahjono, R, Stone, DB, Sritharan, N, Palme, CE et al. Comparison of arytenoid vertical height discrepancy in normal versus patients with vocal cord palsy. Am J Otolaryngol 2020;41:102323CrossRefGoogle ScholarPubMed
Niimi, S. Arytenoid adduction as a surgical treatment for hoarseness with unilateral vocal cord fixation. Ann Bull RIPL 1991;25:1611–17Google Scholar
Maamary, JA, Cole, I, Darveniza, P, Pemberton, C, Brake, HM, Tisch, S. Relationship between laryngeal electromyography and video laryngostroboscopy in vocal fold paralysis. J Voice 2017;31:638–42CrossRefGoogle ScholarPubMed
Al-Khtoum, N, Shawakfeh, N, Al-Safadi, E, Al-Momani, O, Hamasha, K. Acquired unilateral vocal fold paralysis: retrospective analysis of a single institutional experience. N Am J Med Sci 2013;5:699–702CrossRefGoogle ScholarPubMed
Woodson, GE. Configuration of the glottis in laryngeal paralysis. I: clinical study. Laryngoscope 1993;103:1227–34CrossRefGoogle ScholarPubMed