الفهرس 
Anatomy of the larynxOnly 14 pages are availabe for public view
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Abstract
Laryngeal framework surgery offers a safe and usually effective method to improve incomplete glottis closure and adjust vocal fold tension.
Selection of phonosurgical procedures in cases of paralytic dysphonia depends on the severity of patient’s symptoms, glottic configuration, the tone of the paralysed cord and status of paralysis (Temporary or Permanent). Since arytenoid adduction (AA) is an irreversible and complicated procedure compared to Medialization (M. L) it is adapted only in long standing, uncompensated, unilateral vocal cord paralysis with breathy dysphonia and also in cases where it is ascertained that the neuronal function of the affected vocal cord will not return to normal.
Dysphonia due to unilateral vocal fold immobility (UVFI) can have detrimental effects on quality of patient daily lives. Arytenoid adduction and type I thyroplasty are widely accepted treatment methods for UVFI. However, postoperative voice does not always reach normal although dysphonia is improved to a certain degree
The goal of a corrective procedure is to move the edge of the paralyzed vocal fold closer to the midline, to facilitate glottal closure during phonation.
The ideal surgical procedure for correction of glottal incompetence would improve both sphincteric function and sound production while preserving the glottal airway.
Arytenoid adduction (AA) is used in the treatment of glottal insufficiency. Unlike medialization laryngoplasty, AA acts through direct traction on the arytenoid cartilage at the muscular process mimicking the action of the lateral cricoarytenoid muscle. AA is an important adjunct in selected cases of vocal fold paralysis.
In patients with vocal fold paralysis who have a lack of vocal process contact during phonation (large posterior gap), shortened immobile vocal fold and those with vocal folds at different levels, AA should be considered in addition to ML. Videostroboscopy often provides valuable information about vocal process contact, vocal fold height, length and therefore is useful preoperatively in assessing whether a patient may need an AA.
Arytenoid adduction is usually performed in conjunction with the ML procedures. The procedure is performed under local anesthesia, with an indwelling flexible laryngoscope. AA has limited application in patients with previous external beam radiation to neck, in cases of radical neck surgery, in diabetics or in patients who are immuno suppressed from cancer chemotherapy.
The advantages of arytenoid adduction are undisputed. 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 challenging surgical procedure of AA seems to keep many phonosurgeons from performing this (mostly supplementary) procedure while only performing a medialization thyroplasty.
To obtain postoperative voice as close as normal, it is essential to facilitate symmetrical apposition of the vocal folds at the median position in terms of vertical level, thickness and mucosal pliability of the vocal folds, AA moves the IVF medially and caudally resulting in nearly the same vertical position as the healthy vocal fold, IVF can be augmented by Type 1 concurrently performed with AA. The surgical management should aim at a compromise between respiratory and phonatory performance in later situations
Complications and common surgical errors include laryngeal edema with airway compromise, which is more common with framework surgery that involves AA, increased paraglottic and arytenoids edema post operatively. Pharyngocutaneous fistula is a possible complication with AA, although it is quite uncommon. Excessive tension on the AA suture can create over-rotation of the arytenoid and worsening of the voice.