Initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis: A Case series

Objective@#To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution.@*Methods@# Design: Case Series Setting: Tertiary National University Hospital Participants: 17 Patients @*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. @*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.

Características Tomográficas de la Anatomía Laríngea Normal en pacientes que acuden al Servicio de Medicina en Imágenes del Hospital de Clínicas San Lorenzo, Paraguay 2020

RESUMEN Introducción: La tomografía computarizada es el estudio Gold standard para complementar a la endoscopia en el estudio de patologías laríngeas. Por lo tanto, se debe tener conocimiento de la anatomía normal de la laringe. Metodología: Se realizó un estudio observacional descriptivo, de corte transversal retrospectivo. Se recolecto los datos a través del análisis tomográfico, se analizaron 26 tomografías de pacientes que acudieron al Servicio de Imágenes del Hospital de Clínicas sin patología laríngea. Las variables investigadas fueron características tomográficas como: Calcificación cartílagos laríngeos, Altura cartílago tiroideo, Distancia tiro-aritenoidea, Distancia interaritenoidea, Altura y diámetro del espacio preepiglótico. Resultados: Se lograron identificar cada una de las características anatómicas radiológicas buscadas. Además, se realizaron las mediciones correspondientes, detallando el promedio de cada una de las mediciones y clasificándolo por sexo. La altura de cartílago tiroideo la media en hombres fue 28.05±1.2 mm y en mujeres fue 27.8±0.92 mm, para la distancia Tiro-aritenoidea en hombres fue 12.3±1.3 y en mujeres 10.97±0.95 mm, para el diámetro transversal del cartílago tiroideo en hombres fue 16.63±1.58 mm y en mujeres 17.96±1.11 mm. Conclusión: Los promedios de las mediciones realizadas fueron mayor en hombres excepto en el diámetro transversal del cartílago tiroideo, La prevalencia de calcificación de cartílagos laríngeos fue del 54% de los pacientes estudiados.

ABSTRACT Introduction: Computed tomography is the Gold standard study to complement endoscopy in the study of laryngeal pathologies. Therefore, knowledge of the normal anatomy of the larynx is required. Methodology: A retrospective cross-sectional descriptive observational study was carried out. Data were collected through tomographic analysis, 26 tomographies of patients who attended the Imaging Service of the Hospital de Clínicas without laryngeal pathology were analyzed. The variables investigated were tomographic characteristics such as: laryngeal cartilage calcification, thyroid cartilage height, thyro-arytenoid distance, interarytenoid distance, height and diameter of the pre-epiglottic space. Results: Each of the radiological anatomical characteristics sought were identified. In addition, the corresponding measurements were taken, detailing the average of each of the measurements and classifying them by sex. The average thyroid cartilage height in men was 28.05±1.2 mm and in women was 27.8±0.92 mm, for the thyro-arytenoid distance in men was 12.3±1.3 and in women 10.97±0.95 mm, for the transverse diameter of the thyroid cartilage in men was 16.63±1.58 mm and in women 17.96±1. 11 mm. Conclusions: The averages of the measurements taken were higher in men except for the transverse diameter of the thyroid cartilage. The prevalence of laryngeal cartilage calcification was 54% of the patients studied.

Clinical outcomes of vocal fold immobility after tracheal intubation / 北京大学学报(医学版)

OBJECTIVE@#To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.@*METHODS@#We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.@*RESULTS@#A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.@*CONCLUSION@#Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.

Clinical analysis of arytenoid cartilage reposition with snake mouth forceps for the arytenoid cartilage dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the clinical effect of the arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia.@*METHODS@#Data of twenty-six cases accepted arytenoid cartilage reposition under intravenous general anesthesia were analyzed, nineteen cases accepted laryngeal CT scan and cricoarytenoid joint reconstruction, all patients underwent endolaryngeal muscle electromyography examination. According to the position of cartilage dislocation prompted by laryngoscope and CT, the arytenoid cartilage was repositoned under the visual laryngoscope using special snake mouth reduction forceps. If bilateral arytenoid cartilage were still asymmetrically at the end of the surgery, patients needed repeated reposition 1 to 2 times 1 week after operation. The efficacy was evaluated 4 weeks later.@*RESULTS@#All patients had a hoarse and breathing voice preoperative. Under laryngoscope, there were different degrees of vocal cord movement disorders accompanied by incomplete glottis closure, 22 cases happened in left side and 4 in right side. The arytenoid cartilage was dislocated anteromedially in 25 cases and posterolaterally in 1 case. CT showed that 15 cases of arytenoid cartilage were tilted anteromedially; the interval of the cricoarytenoid joint was widened. In axial CT images, there were no direct signs of the arytenoid cartilage dislocation in the 4 cases, but the abnormal position was seen in the reconstruction images. The laryngeal electromyography indicated that 7 cases were abnormal, duration of motor unit potential were visible and the raising potential were mixed. There were 4 patients with normal voice in the first day after surgery, and 19 cases underwent twice and 3 cases underwent three times surgery. Vioce became normal in 4 weeks. Swallowing pain and bucking were all disappeared. Vocal cords movement were recovered to normal level in 25 cases. In 1 case with neck strangulation, the vocal cord movement was slightly worse than health side, but significantly better than that before operation.@*CONCLUSIONS@#The arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia was an effective method for the treatment of the cricoary-tenoid joint dislocation.

The diagnostic value of laryngeal electromyography in vocal fold paralysis and arytenoid dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To identify diagnostic value of laryngeal electromyography (LEMG) in differentiating vocal fold paralysis (VFP) from arytenoid dislocation.@*METHODS@#The history, laryngeal morphologic characteristics and LEMG of 36 patients with VFP and 10 patients with arytenoid dislocation were compared and analyzed.@*RESULTS@#The most common cause of 36 VFP patients was surgical damage (24 cases), and the most common cause of 10 arytenoid dislocation patients was history of endotracheal intubation (9 cases). There was no statistical difference between the vocal fold and the fixed position of the vocal fold between the group of VFP patients and arytenoid dislocation patients. In the patients with VFP, 33 VFP patients (91.67%) had decreased recruitment; 9 cases (9/13) of denervation potential and 8 cases (8/9) of regeneration potential occurred within 1-6 months of the course of disease; 3 cases (3/4) of synkinesis occurred in the course of disease more than 6 months. In the patients with VFP, the amplitude (<0.01) and turns (<0.05) of thyroarytenoid muscles significantly decreased in the lesioned side comparing to the normal one, but the turns/amplitude ratio showed no statistical difference. In the patients with superior laryngeal nerve injury, the turns and amplitude analysis of cricothyroid muscles showed no statistical difference. All of 10 patients with arytenoid dislocation showed normal LEMG patterns.@*CONCLUSIONS@#LEMG can be used to differentiate the patients with vocal cord paralysis from arthrodesis dislocation, and can also carry out quantitative analysis to provide valuable help for the diagnosis.

Swallowing and Aspiration: How Much Is Affected by the Number of Arytenoid Cartilages Remaining After Supracricoid Partial Laryngectomy?

OBJECTIVES: The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions. METHODS: Supracricoid partial laryngectomy (SCPL) with the diagnosis of laryngeal cancer between 2012 and 2014 were retrospectively evaluated. The patients were categorized into two groups as follows: group I, patients who underwent SCPL with one arytenoid cartilage and group II, patients who underwent SCPL with two arytenoid cartilages. The time of decannulation and oral feeding onset, and swallowing-aspiration functions were evaluated and compared in the early nutritional period, first, and third months. RESULTS: There was no significant correlation between decannulation time and swallowing-aspiration. The aspiration rates in group I and group II were similar and there was no significant difference in oral feeding onset and aspiration grades in the first and third months between both groups. CONCLUSION: We found similar oncological and functional outcomes in SCPL which protected one or two arytenoid cartilages. Therefore we suggest to be performed one arytenoid cartilage SCPL in selected patients who was advance stage and tumor volume over with larynx cancer.

Comparison of Voice Outcomes between Medialization Thyroplasty and Arytenoid Adduction with or without Injection Laryngoplasty in Unilateral Vocal Fold Paralysis Patients

BACKGROUND AND OBJECTIVES: In unilateral vocal fold paralysis (VFP), medialization thyroplasty (MT), arytenoid adduction (AA) and injection layrngoplasty (IL) are the most common procedures to correct phonatory problems. There is no consensus that which procedure is superior to the other for correcting the glottal insufficiency. The purpose of this study was to compare the phonatory parameters between MT, AA and AA with IL (AA+IL) in patients with unilateral VFP. MATERIALS AND METHODS: This retrospective study enrolled patients from 2005 to 2016. Total 72 patients (49 male, 23 female, mean age 54.5 years) were classified into three groups ; MT (n=28), AA (n=12), and AA+IL (n=32). GRBAS scales, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), and voice handicap index (VHI)-10 and VHI-30 were preoperatively and postoperatively collected and compared between the three groups. RESULTS: Age, gender and cause of VFP were not significantly different between the three groups. In MT and AA groups, MPT, VHI, G (overall grade) and B (breathiness) were significantly improved. In AA+IL group, jitter, shimmer, NHR, MPT, VHI, G and B were significantly improved. In analysis of differences (pre-postoperative values), Δ jitter (p < 0.001), Δ shimmer (p=0.031), and Δ NHR (p=0.002) were significantly different and AA+IL group showed the greatest improvement. CONCLUSION: Analysis of voice parameters showed that all the three procedures for patients with unilateral VFP are effective in the improvement of voice ; especially in MPT, VHI-10, G and B scales. Compared to the others, AA+IL provided the better acoustic values including jitter, shimmer and NHR.

Clinical Research of CO2 Laser Resection of the Paraglottic Space and Arytenoid for the Treatment of Bilateral Vocal Cord Paralysis / 中国微创外科杂志

[Summary] This paper reported 10 patients with bilateral vocal cord paralysis from March 2013 to October 2015.The paraglottic space and arytenoid were resected with CO 2 laser.The endotracheal intubation was removed at 3 months after surgery .The patients were followed up for 1-2 years.No dyspnea or eating difficulty was seen .Patient’ s voice was normal.The cavity mucous membrane was smooth .No complications such as granulation tissue growth occurred .

Progress of Surgical Treatment for Vocal Cord Movement Disorders / 中国微创外科杂志

[Summary] Vocal cord movement disorders may lead to hoarseness,dysphonia or even dyspnea.They reduce the quality of speech,destroy social communications,or even are life-threatening.For patients with vocal cord movement disorders which are not sensitive to the treatment of phonation training or medication,surgical procedures can improve the quality of phonation.At present, with operation methods for vocal fold movement disorders developing rapidly,types of the operations are exploring,while at the same time the situations of confusion or repetition of operation methods and terminologies increase.On this condition,we summarized different types of surgeries for vocal cord movement disorders by reviewing relevant literatures.

Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report / 대한마취과학회지

Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position.

Arytenoid dislocation after uneventful endotracheal intubation: a case report / 대한마취과학회지

Arytenoid dislocation is an unusual complication of endotracheal intubation. We reported a case of a 48-year-old female with arytenoid dislocation after uneventful endotracheal intubation, which was successfully treated with arytenoid reduction. The patient complained of persistent hoarseness until the fourth day after an uneventful gynecologic surgery under general anesthesia. On laryngoscopic examination, paralyzed left vocal cord with minimal arytenoid movement was observed. An anteromedial dislocation of the left arytenoid cartilage was suspected and surgical reduction was performed by the laryngologist. The hoarseness was immediately resolved after surgical intervention. Anesthesiologists should be careful not to cause laryngeal trauma in anesthetized patients. In addition, early diagnosis and prompt surgical reduction are essential for a better prognosis for arytenoid dislocation.

The Clinical Characteristics of Unilateral Vocal Fold Paralysis and Arytenoid Dislocation / 听力学及言语疾病杂志

Objective To investigate the value of clinical characteristics in diagnosis of vocal fold paralysis (VFP) and arytenoid dislocation .Methods Eighty - eight patients of VFP and 27 patients of arytenoid dislocation were studied , by comparing the causes , laryngeal morphologic characteristics and laryngeal electromyography (LEMG) .Results The causes of 88 VFP patients included surgery (45 cases) ,neck trauma(2 cases) ,idiopathic causes(16 cases) ,infection(16 cases) ,and tumor invasion - related(9 cases) .Of the 27 arytenoid dislocation pa‐tients ,24 had a history of endotracheal intubation and the others had a history of gastric tube insertion .The vocal folds were mostly fixed at the paramedian position ,followed by the abducent position and the median position .No significant differences were found in laryngeal morphologic characteristics between the two groups ,including vocal fold shape , glottis vertical symmetry , mucosal waves , supraglottic compensation , glottis closure and arytenoid movement .The LEMG of VFP patients appeared as denervation patterns ,reinnervation potentials ,or electrical si‐lence ;the recruitment patterns appeared as mix or simple patterns ;the evoked potentials were absent .Of the VFP patients ,54 cases(61 .36% % )were found synkinesis of involved posterior cricoarytenoid and two of them also in ‐volved thyroatenoid .The patients with synkinesis had lower percentage of vocal fold bowing and higher percentage of glottic vertical asymmetry compared to the ones without synkinesis .Of the VFP patients whose cause was surgery or neck trauma ,the median - position fixed vocal folds were mostly observed in the patients with duration of less than 1 month or with synkinesis .Of the 27 arytenoid dislocation patients ,20(74 .07% )showed normal LEMG pat‐terns and 7(25 .93% )showed apparent LEMG abnormality on the affected side .Conclusion The causes of vocal fold paralysis and arytenoid dislocation are different .Laryngeal morphologic characteristics have limitations in distinguis‐hing vocal fold paralysis from arytenoid dislocation .The shape and position of involved vocal folds of the VFP pa‐tients are correlated with duration ,nerve regeneration and synkinesis .

Solitary Extramedullary Plasmacytoma of the Apex of Arytenoid: Endoscopic, CT, and Pathologic Findings

Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm that occurs mainly in the soft tissues of head and neck region, with the paranasal sinuses, nasal cavity and nasopharynx being the most common sites. Solitary EMP of the larynx is very rare but increasingly reported recently. Common sites of involvement in larynx in the order of frequency are the epiglottis, ventricles, vocal folds and ventricular folds. We report an extremely rare case of solitary EMP involving in the apex of arytenoids that was successfully treated by only surgical excision. Because solitary EMP of the apex of artytenoids is extremely rare, it should be included in the differential diagnosis for laryngeal mass. Also, solitary, small, pedunculated and localized EMP of the larynx could be completely removed by laryngeal microsurgery.

A Case of Bilateral Vocal Cord Paralysis in a Patient with Rheumatoid Arthritis / 대한이비인후과학회지

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovial membrane and causing joint damage and bone destruction. The symptoms of cricoarytenoid joint (CJ) arthritis often include hoarseness, and a sense of pharyngeal fullness in the throat. Sometimes, in cases with bilateral CJ involvement, an urgent tracheostomy might be required for acute airway obstruction. In this report, we describe a 45-years-old man suffering from voice change and aspiration due to hampered adduction of the vocal fold that was caused by RA with bilateral CJ involvement. The medication treatment for RA was carried out and the patient retrieved her normal voice after one month.

Modified Arytenoid Adduction for Unilateral Vocal Fold Paralysis / 听力学及言语疾病杂志

Objective To evaluate the efficacy of modified arytenoid adduction in the management of patients with unilateral vocal fold paralysis(UVFP).Methods A retrospective review was performed on 22 patients who underwent modified arytenoid adduction for UVFP between February 2001 and December 2007.Pre-,and 3 months postoperative aspiration,perceptual(GRBAS),acoustic data(fundamental frequency,F_0,fundamental frequency perturbation,jitter,amplitude perturbation,shimmer,normalized noise energy,NNE)and aerodynamic(maximal phonatory time,MPT,mean airflow rate,MFR)were analyzed statistically.Results The ratings of postoperative aspiration were significantly decreased than that of the preoperation(P<0.0001).There was a significant decrease in GRBAS scales postoperatively versus preoperatively(P<0.0001).The mean values of voice acoustics parameters (F_0,jitter,shimmer,NNE)were significantly decreased,the maximum phonation time were significantly longer,and the mean airflow rate were significantly decreased after operation than that of the preoperation(P<0.001).Conclusion Modified arytenoid adduction is an effective medialization technique that can restore satisfactory speech and prevent aspiration in patients with UVFP.

Resection range of dog hemi-vertical larynx by semiconductor laser / 第二军医大学学报

Objective: To observe the resection range of dog hemi-vertical larynx by semiconductor laser. Methods: Twelve dogs were randomly divided into three groups (A, B and C, n = 4). Group A: the hemi-vertical larynx was cauterized forward from the anterior commissure to thyroid cartilage internal membrane, outwards including the right vocal cords. Group B: the hemi-vertical larynx was cauterized forward from anterior commissure to thyroid cartilage internal membrane and partial cartilage of anterior commissure, outwards including the right ventricular fold, vocal cord, thyroarytenoid muscle and partial lateral cricoarytenoid muscle, downwards including the lower edge of thyroid cartilage, and backwards including the partial arytenoid cartilage. Group C: the hemi-vertical larynx was cauterized forward including the anterior commissure and partial thyroid cartilage of anterior commissure, outwards including the right ventricular fold, vocal cord, thyroarytenoid muscle, lateral cricoarytenoid muscle and paraglottic space to thyroid cartilage, downwards including the partial cricothyroid membrane to the upside of cricoid cartilage, and backwards including total right arytenoid cartilage. The recovery of the laryngeal wounds, hoarseness, and complications were observed and evaluated by using digital camera and electrolaryngoscope immediately, 1 week and 4 weeks after operation. The treatment outcome of the resection was evaluated. Results: The laser surgery was completed successfully in all the animals. Laryngoscope showed that the neonatal membrane covered the wound in group A and B one week later, without obvious complications. The neonatal membrane covered part of the wound in group C, accompanied by inflammatory reaction and cough when eating. Four weeks later the new membrane over the wound surface were smooth in all the three groups; adhesion appeared in the anterior commissure and new anterior commissure was formed. A new vocal cord was formed in group A; only a small gap was seen when the glottis was closed. In Group B, the new vocal cord was narrower and thinner; granulation growth was seen in local areas; and the glottis was closed incompletely. In Group C, mucosa was slightly raised over the original location of the vocal cord. Closure of the glottis was poor. Group A had no hoarseness, Group B had moderate, and Group C had severe hoarseness, but without cough when eating. Also in Group C the lamina of thyroid cartilage of the operative side was thinner than that of the contralateral side. Conclusion: When cauterizing dog partial hemi-vertical larynx using semiconductor laser, we can resect all the soft-tissue internal the thyroid cartilage, including the arytenoid and partial thyroid cartilage in the anterior commissure. The repair is satisfactory after operation, without obvious complications.

Transoral CO2 Laser Resection for Post-Radiation Arytenoid Edema

Arytenoid edema following radiation therapy of laryngeal cancer may persist and make careful inspection and evaluation of the larynx difficult. Moreover, it may have serious impacts on functions such as breathing, swallowing, speech and voice. Conservative management such as antibiotics and steroid may be attempted but may be ineffective in progressive and severe cases of edema. We present four cases of persistent postradiation arytenoid edema successfully treated with partial resection of the arytenoid mucosa using transoral CO2 laser.

An Unusual Case of Extramedullary Plasmacytoma Occurring in Arytenoid Apex / 대한이비인후과학회지

Extramedullary plasmacytoma (EMP) is a rare plasma cell neoplasm occurring anywhere in the body. Paranasal sinus is the most commonly involved site of head and neck region, and then nasal cavity, oropharynx on the decreasing frequency. EMP of larynx is quite rare and only two cases of EMP were reported to have occurred in the epiglottis and the false cord of larynx, respectively, in the Korean literature. We report an unusual case of EMP occurring in the arytenoid that was treated by surgical excision.

A primary study of arytenoid within-shift combining with recurrent laryngeal nerve transposition / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the therapeutic effect of arytenoid within-shift combining with recurrentlaryngeal nerve (RLN) anastomosis to ansa cervicalis for patients with long-term unilateral vocal cord paralysis (UVCP) . METHODS Twelve patients with traumatic RLNs paralysis were studied. The courses of injury varied from 3 to 22 years. RLN was anastomosed to ansa cervicalis and arytenoid was within-shifted on ipsilateral side in all patients. Therapeutic efficacy was evaluated by laryngoscope, strobe-laryngoscope, voice evaluation, voice acoustics parameter analysis, and laryngeal electromyography (LEMG) . RESULTS The voice was improved in all cases after arytenoid within-shift immediately. The mean values of voice acoustics parameters (jitter, shimmer, NNE) were significantly smaller and maximum phonation time (MPT) were significantly longer after operation compared with those of before treatment. Laryngoscope showed that arytenoid was significantly within-shifted. The glottic posterior chink vanished in 9 cases and reduced in 3 cases. The voice resumed normal, obviously improved, improved and no improved were found in 9、 3、0、0 cases respectively 12 months after operation. The mass and tension of all treated vocal cords may become the same as the contralateral normal vocal cords, thus resuming symmetric vibration of the vocal cords. The reinnervation of the RLNs were approved by LEMG in these patients whose RLNs were restored. CONCLUSION Arytenoid within-shift combining with RLN anastomosis to ansa cervical can restored normal voice in patients with long-term UVCP.

The Study for Various Movements of the Arytenoid Cartilage in Functional Diseases of Vocal Folds / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Functional diseases of vocal folds have shown various movements of the arytenoid cartilage, however, they have not been documented yet. We studied to find out the relationships between functional diseases of vocal folds and arytenoid movements. MATERIALS AND METHOD: 224 subjects were evaluated by using videostroboscopic examinations. The subjects were classified into three types; notch, ball, and flat types according to the patterns of arytenoid movement during phonation. Vocal fold lesions were investigated and arytenoid movements were compared between normal and disease groups. RESULTS: The arytenoid movements of notch type were more than ball type or flat type in both normal and disease groups. The disease group showed many asymmetric movements of arytenoid cartilage when compared with the normal group. Vocal nodule and vocal polyp showed asymmetric movements of arytenoid cartilage. Conclusions: We found that the functional diseases of vocal folds were related to the asymmetric movements of arytenoid cartilage. We suggest that the various movements of arytenoid cartilage should be considered when functional diseases of vocal folds are examined.