Characteristics of the Voice Handicap Index for Patients With Unilateral Vocal Fold Paralysis Who Underwent Arytenoid Adduction.

PURPOSE: This study was performed to evaluate the characteristics of the Voice Handicap Index (VHI), a self-assessment measure, for patients with unilateral vocal fold paralysis (UVFP) who underwent arytenoid adduction (AA), in comparison with postoperative vocal function examinations. METHODS: A retrospective chart review was conducted for patients who underwent AA at Tohoku University Hospital during the period between 2014 and 2017. VHI was compared before and after surgery; moreover, correlations were assessed between the VHI and other voice measurements, including perceptual assessment of voice, as well as aerodynamic and acoustic measures. Factors involved in the VHI score were explored by multivariate analysis. RESULTS: Forty-three UVFP patients (28 males, age 32-81 years; 15 females, age 34-80 years) were enrolled in the study; the average age of all patients was 61.5 years (32-81 years). Among the enrolled patients, 33 (76.7%) left and 10 (23.3%) right vocal folds were impaired. After surgery, nearly all of the patients exhibited significantly improved VHI score; each of the three subscales (functional, physical, and emotional) was also improved. The postoperative VHI correlated mildly with several values of the other voice measurements, with the exception of the mean flow rate. Multivariate analysis showed that the sole variable associated with postoperative VHI score was preoperative VHI. CONCLUSIONS: The postoperative VHI likely reflects improvement in the voices of the patients with UVFP. Although there were weak correlations with other voice measures, postoperative VHI is a relatively independent measurement parameter for patients with UVFP who underwent AA.

Surgical Impact of the Montgomery Implant System on Arytenoid Cartilage and the Paralyzed Vocal Fold.

OBJECTIVES/HYPOTHESIS: Medialization thyroplasty (MT) has become a prominent method for treating glottal insufficiency. This study aimed to visualize the biomechanical influence of a medialization implant on arytenoid cartilage, particularly on the length and level of paralyzation in the vocal fold, in patients with unilateral vocal fold paralysis. STUDY DESIGN: Prospective study. METHODS: We recruited 15 patients (10 men, 5 women) with unilateral vocal fold paralysis that underwent MT with a Montgomery® thyroplasty implant. We performed high-resolution computed tomography of the arytenoid cartilage before and after MT and analyzed the three-dimensional images. To visualize the movement of the arytenoid and to measure the lengthening of the vocal fold, we superimposed pre- and postoperative 3D images with MIMICS software. RESULTS: On the affected side, the implant pushed the arytenoid backwards. In addition, the vocal process of the arytenoid was inwardly rotated. These movements resulted in an elongated, augmented vocal fold on the affected side. CONCLUSION: MT led to an elongated, medialized vocal fold on the treated side. After the intervention, the vocal folds on both sides were the same length in the phonatory position.

Regularity of voice recovery and arytenoid motion after closed reduction in patients with arytenoid dislocation: a self-controlled clinical study.

Background: Closed reduction is an effective treatment for arytenoid dislocation. The treatment is usually given more than once to obtain normal voice. However, when to perform the next closed reduction remains controversial.Objective: This study aimed to observe the regularity of the voice recovery and the arytenoid motion in patients with arytenoid dislocation after closed reduction.Material and methods: Thirty-one patients were recruited from September 2017 to April 2019. Results of their clinical data were reviewed retrospectively.Results: Among the thirty-one patients, their VHI scores, F0, jitter%, shimmer%, glottal-to-noise excitation %(GNE), maximum phonation time (MPT) and GRBAS Scale (G, R, B, A) improved significantly (p < .05), but there was no statistically significant difference for GRBAS Scale (S) (p>.05). The duration between last closed reduction and the restoring normal voice ranged from 1-8 days, with a mean of 4.65 ± 0.57 days, at the same time the glottis was completely closed.Conclusions and significance: Closed reduction for patients with arytenoid dislocation is an effective procedure. A time window between 4.08th and 5.22th day (at a confidence level of 95%) after the last closed reduction was identified to be critical for voice recovery.

Reliability and Construct Validity of the Penetration-Aspiration Scale for Quantifying Pediatric Outcomes after Interarytenoid Augmentation.

OBJECTIVE: To assess the reliability and construct validity of the Penetration-Aspiration Scale in children. STUDY DESIGN: This was a retrospective cohort study of pre- and postoperative video modified barium swallow studies from children who underwent interarytenoid injection augmentation for unexplained persistent pharyngeal dysphagia. Two pediatric speech and language pathologists reviewed each study twice in a blinded and randomized fashion. SETTING: Tertiary academic pediatric hospital. SUBJECTS AND METHODS: Thirty children were identified with adequate pre- and postoperative modified barium swallow studies within 4 weeks of intervention. Children were separated into clinical outcome groups based on ability to advance to thinner diet consistencies postoperatively. Construct validity was assessed with a mixed linear model to test the hypothesis that only the clinically improved group would receive better Penetration-Aspiration Scale scores after surgery. Reliability was assessed by calculating chance-corrected agreement between raters (interrater) and raters' repeat evaluations (intrarater). RESULTS: Inter- and intrarater reliabilities (Cohen's κ) were both excellent. Results of the mixed model revealed a significant interaction between outcome group and pre- and postoperative time interval. As hypothesized, this involved a significant improvement in Penetration-Aspiration Scale score only in the improved group. CONCLUSIONS: These findings suggest that the Penetration-Aspiration Scale is a reliable and valid measure of clinical response to interarytenoid injection augmentation in children.

Cricoarytenoid Joint Ankylosis: Classification and Transoral Laser Microsurgical Treatment.

OBJECTIVE: This study aimed to describe a graduated approach for effective transoral mobilization of cricoarytenoid joint ankylosis (CJA) in the context of the Bogdasarian system of classifying posterior glottic web-based stenosis (PGWS). STUDY DESIGN: This is a retrospective cohort study through data from medical records and operative notes. A consecutive series of 23 patients who underwent reconstructive transoral laser microsurgery for PGWS with a significant degree of CJA (Bogdasarian grade III-IV) was included in the study. METHODS: Techniques necessary to remobilize their cricoarytenoid joints were reviewed in the context of the extent of scar tissue found. RESULTS: Arytenoids with CJA were successfully mobilized by resection of the fused portion of the cricoid and arytenoid cartilages achieving respiratory improvements as well as decannulation of tracheostomy-dependent patients. The majority (83%) of patient's voices improved. All patients tolerated a full diet after the procedures. Cases with Bogdasarian grade III PGWS with minor unilateral fixation should be classified as IIIa. If the fixation is severe, the case should be classified as a grade IIIb. Grade IVa would indicate that both sides were mildly to moderately ankylosed, and grade IVb involves ankylosis of both joints with subtotal or complete fusion of at least one; it presents the greatest surgical challenge. CONCLUSION: We provided effective transoral techniques for the re-mobilization of cricoarytenoid joint, along with a classification of CJA that aims to standardize the severity of disease in the context of the existing and widely accepted Bogdasarian scale.

Detection of Arytenoid Dislocation Using Pixel-valued Cuneiform Movement.

OBJECTIVES: This study aims to assess utility of pixel-valued movement software in detecting arytenoid dislocation preoperatively. STUDY DESIGN: This is a retrospective analysis. METHODS: Twenty-seven patients diagnosed with unilateral arytenoid dislocation were included. Diagnosis of arytenoid dislocation was confirmed by lack of vocal fold paralysis on preoperative laryngeal electromyography and by intraoperative findings of cricoarytenoid dislocation. A region-tracking software algorithm developed by Zhuang et al was used to analyze 27 preoperative endoscopic videos of patients diagnosed with arytenoid dislocation. Vector analysis measuring cuneiform movement during inspiration was used as an indirect measure of arytenoid movement. Values were normalized using vocal fold length. Two raters blinded to diagnosis of arytenoid dislocation measured vocal fold length and cuneiform movement on both the dislocated and the nondislocated sides. RESULTS: A Wilcoxon signed-rank test indicated that the mean pixel-valued cuneiform movement and standard deviation (SD) were greater for nondislocated (159.24, SD = 73.35) than for dislocated (92.49, SD = 72.11) arytenoids (Z = 3.29, P = 0.001). The interrater correlation coefficient was 0.87 for the dislocated side and 0.75 for the nondislocated side. The intrarater correlation coefficient was 0.87 for the dislocated side and 0.91 for the nondislocated side. The receiver operating characteristic curve revealed an area under the curve between 0.76 and 0.83 (95% confidence interval 0.63-0.90). Analysis by the first and second raters revealed misdiagnosis of laterality of arytenoid dislocation in four and six patients, respectively. CONCLUSIONS: The software program developed by Zhuang et al provides a high-degree of precision, with good interrater and intrarater correlation coefficients. However, high rates of misdiagnosis of arytenoid dislocation and the laborious analysis process using this software program make it of limited utility as a clinical diagnostic tool in its present state.

Quantitative Measurement of the Three-dimensional Structure of the Vocal Folds and Its Application in Identifying the Type of Cricoarytenoid Joint Dislocation.

OBJECTIVE: The objective of this study was to quantitatively measure the three-dimensional (3D) structure of the vocal folds in normal subjects and in patients with different types of cricoarytenoid dislocation. We will analyze differences in parameters between the groups and also determine if any morphologic parameters possess utility in distinguishing the type and the degree of cricoarytenoid dislocation. STUDY DESIGN: This retrospective study was conducted using university hospital data. METHODS: Subjects' larynges were scanned using dual-source computed tomography (CT). The normal subjects were divided into deep-inhalation and phonation groups, and patients with cricoarytenoid joint dislocation were divided into anterior-dislocation and posterior-dislocation groups. Membranous vocal fold length and width were measured directly on the thin-section CT images. Vocal fold and airway 3D models were constructed using Mimics software and used in combination to measure vocal fold thickness, subglottal convergence angle, and oblique angle of the vocal folds. RESULTS: The phonation group displayed a greater vocal fold width, greater oblique angle, thinner vocal folds, and a smaller subglottal convergence angle than those of the deep-inhalation group (P < 0.05). The anterior-dislocation group displayed a smaller oblique angle and subglottal convergence angle than the posterior-dislocation group (P < 0.05). CONCLUSIONS: The 3D structure of the vocal folds during deep inhalation and phonation can be accurately measured using dual-source CT and laryngeal 3D reconstruction. As the anterior-dislocation group yielded negative values for the oblique angle and the posterior-dislocation group yielded positive values, the oblique angle of the vocal folds may possess utility for distinguishing the type and for quantitatively determining the degree of cricoarytenoid dislocation.

Assessment of vocal cord movement by ultrasound in the ICU.

PURPOSE: Ultrasound can be used to non-invasively and rapidly examine airway conditions, but vocal cord visualization with the traditional approaches is poor. Our aim was to compare the accuracies of front-side transverse-axis ultrasound (FTU), lateral-side longitudinal-axis ultrasound (LLU), and the combination of both approaches for vocal cord movement disorder diagnoses (e.g., vocal cord paralysis or arytenoid cartilage dislocation). METHODS: We compared FTU, LLU, and the combination of both methods for patients in the intensive care unit (ICU). We used nasal fiber-optic endoscopy to confirm vocal cord injury. RESULTS: Among the 120 patients examined, 24 (20%) had vocal cord paralysis. The visualization rate of vocal cords for FTU was 71.7% (assessable, 86; non-assessable, 34), that for LLU was 88.3% (assessable, 106; non-assessable, 14), and that for the combined approach was 96.7% (assessable, 116; non-assessable, 4). The sensitivities and specificities were 58.3% (14/24) and 75% (72/96) for FTU, 91.7% (22/24) and 87.5% (84/96) for LLU, and 100% (24/24) and 95.8% (92/96) for the combined approach. Visualization rates for LLU were significantly higher than for FTU (P = 0.002); FTU + LLU rates were higher than those for FTU (P = 0.001). The difference between LLU and FTU + LLU was not statistically significant (P = 0.025). CONCLUSION: LLU can be used to evaluate arytenoid cartilage activity in ICUs, and the results are highly correlated with the diagnosis of nasal fiber-optic endoscopy. The combination of FTU and LLU shows promise as a rapid primary screening method for vocal cord injury.

Arytenoid cartilage movements are hypokinetic in Parkinson's disease: A quantitative dynamic computerised tomographic study.

BACKGROUND: Voice change is one of the earliest features of Parkinson's disease. However, quantitative studies of vocal fold dynamics which are needed to provide insight into disease biology, aid diagnosis, or track progression, are few. METHODS: We therefore quantified arytenoid cartilage movements and glottic area during repeated phonation in 15 patients with Parkinson's disease (symptom duration < 6 years) and 19 controls, with 320-slice computerised tomography (CT). We related these measures to perceptual voice evaluations and spirometry. We hypothesised that Parkinson's disease patients have a smaller inter-arytenoid distance, a preserved or larger glottic area because vocal cord bowing has previously been reported, less variability in loudness, more voice dysdiadochokinesis and breathiness and a shortened phonation time because of arytenoid hypokinesis relative to glottic area. RESULTS: Inter-arytenoid distance in Parkinson's disease patients was moderately smaller (Mdn = 0.106, IQR = 0.091-0.116) than in controls (Mdn = 0.132, IQR = 0.116-0.166) (W = 212, P = 0.015, r = -0.42), normalised for anatomical and other inter-subject variance, analysed with two-tailed Wilcoxon's rank sum test. This finding was confirmed in a linear mixed model analysis-Parkinson's disease significantly predicted a reduction in the dependent variable, inter-arytenoid distance (b = -0.87, SEb = 0.39, 95% CI [-1.66, -0.08], t(31) = -2.24, P = 0.032). There was no difference in glottic area. On perceptual voice evaluation, patients had more breathiness and dysdiadochokinesis, a shorter maximum phonation time, and less variability in loudness than controls. There was no difference in spirometry after adjustment for smoking history. CONCLUSIONS: As predicted, vocal fold adduction movements are reduced in Parkinson's disease on repeated phonation but glottic area is maintained. Some perceptual characteristics of Parkinsonian speech reflect these changes. We are the first to use 320-slice CT to study laryngeal motion. Our findings indicate how Parkinson's disease affects intrinsic laryngeal muscle position and excursion.

Diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults.

OBJECTIVES: To study the diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults. MATERIAL AND METHODS: A retrospective study included patients with unilateral vocal-fold immobility undergoing laryngeal electromyography between 2007 and 2015. Neurogenic, normal or myogenic findings were compared to the clinical aspect. Prognosis for recovery was assessed from motor unit potentials on laryngeal electromyography, and compared to subsequent progress on laryngoscopy. RESULTS: Sixty-three patients (mean age, 59 years) were initially included; 2 were subsequently excluded from analysis. Mean time from onset of immobility to laryngeal electromyography was 7 months. 85% of the 61 patients showed neurogenic findings, indicating neural lesion; 13% showed normal electromyography, indicating cricoarytenoid joint ankylosis; and 1 patient showed a myogenic pattern. Neurogenic cases were usually secondary to cervical surgery. Thirty-eight patients were followed up. In total, 75% of patients showing reinnervation potentials recovered. The positive predictive value of laryngeal electromyography was 69.2%. CONCLUSION: Laryngeal electromyography is effective in specifying the origin of unilateral vocal-fold immobility in adults. It also has a prognostic role, lack of reinnervation potentials being a possible indication for early medialization surgery.

[Acoustic analysis in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis].

OBJECTIVE: To analysis the acoustic characteristics in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis, and evaluate the application value of acoustic analysis technique in these two diseases. METHOD: The voice signals of sustained vowel /a/ were measured using the software MDVP in 50 healthy adults and 67 patients with unilateral vocal cord movement disorders. The acoustic parameters (jitter, shimmer, NHR and F0) were analyzed. All patients were divided into arytenoid dislocation group (36 cases) and vocal fold paralysis group (31 cases) through the laryngeal electromyography. All groups were divided into male and female group again. The acoustic characteristics between the two experimental groups and normal control groups were observed and compared. Results were analyzed using Rank sum test. RESULT: (1) In both male or female groups, there were significant differences in jitter and shimmer between two experimental group and control group. In both male or female groups, there were significant differences in NHR between arytenoid dislocation group and control group. There were no significant differences in NHR between vocal fold paralysis group and control group. Except for the male vocal fold paralysis group, there were significant differences in F between the other experimental groups and control groups. (2) In both male or female groups, there were no significant differences in jitter and shimmer between vocal fold paralysis group and arytenoid dislocation group. There were significant differences in NHR. CONCLUSION: The acoustic parameters are effective parameters to measure the voice quality of patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis. NHR is the most sensitive parameter in the distinction of vocal cord paralysis and arytenoid dislocation.

Diagnosis and management of unilateral thyroarytenoid muscle palsy.

The objective of this study is to assess and propose a method of diagnosis and management of patients with unilateral thyroarytenoid muscle palsy (TAMP). This is a retrospective review of clinical records. The records of seven patients diagnosed as having idiopathic TAMP were reviewed. Despite the adductive and abductive functions of the vocal folds being within normal range, apparent palsy was seen in the unilateral thyroarytenoid muscle of these patients. TAMP was confirmed by laryngeal electromyography, and the adductive and abductive movements of the vocal folds were evaluated as the mobility of the arytenoid cartilages by three-dimensional computed tomography and endoscopy. Most of patients with TAMP had been diagnosed as having other diseases or normal, and in one patient, it took over 6 years to establish a correct diagnosis. Two patients recovered by conservative treatment; however, in five patients, TAMP remained even after 6 months. In 4 of those 5 patients, treatment with hyaluronic acid injections was performed. In the remaining patient, surgical treatment, namely, nerve-muscle pedicle flap implantation was performed, which resulted in a favorable recovery of phonation. The average maximum phonation time (MPT) of all patients was extended from 11.4 (±4.4) s before treatment to 19.9 (±4.3) s after treatment, and the pitch range was also increased from 25.1 (±7.2) to 34.6 (±5.8) semitones following our management course. Our results indicate that there is a possibility that TAMP can be diagnosed and treated sufficiently. Therefore, further research toward establishing the concept of and treatment for TAMP is anticipated.

Features of Vocal Fold Adductor Paralysis and the Management of Posterior Muscle in Thyroplasty.

OBJECTIVE: To present the pathologic characteristics of unilateral recurrent nerve adductor branch paralysis (AdBP), and to investigate the management of posterior cricoarytenoid (PCA) muscle on the basis of our experience of surgical treatment for AdBP. STUDY DESIGN: This is a retrospective review of clinical records METHODS: Four cases of AdBP, in which surgical treatment was performed, are presented. AdBP shows disorders of vocal fold adduction because of paralysis of the thyroarytenoid and lateral cricoarytenoid muscles. The PCA muscle, dominated by the recurrent nerve PCA muscle branch, does not show paralysis. Thus, this type of partial recurrent nerve paresis retains the abductive function and is difficult to distinguish from arytenoid cartilage dislocation because of their similar endoscopic findings. The features include acute onset, and all cases were idiopathic etiology. Thyroarytenoid muscle paralysis was determined by electromyography and stroboscopic findings. The adduction and abduction of paralytic arytenoids were evaluated from 3 dimensional computed tomography (3DCT). RESULTS: In all cases, surgical treatments were arytenoid adduction combined with thyroplasty. When we adducted the arytenoid cartilage during inspiration, strong resistance was observed. In the two cases where we could cut the PCA muscle sufficiently, the maximum phonation time was improved to ≥30 seconds after surgery, from 2 to 3 seconds preoperatively, providing good postoperative voices. In contrast, in the two cases of insufficient resection, the surgical outcomes were poorer. CONCLUSIONS: Because the preoperative voice in AdBP patients is typically very coarse, surgical treatment is needed, as well as ordinary recurrent nerve paralysis. In our experience, adequate PCA muscle resection might be helpful in surgical treatment of AdBP.

Quantitative Analysis of the Visor-Like Vertical Motion of the Cricoarytenoid Joint in the Living Subject.

OBJECTIVES: The cricoarytenoid joint has a loose capsule and large cavity and may allow the arytenoid distanced from the cricoid cartilage. The objective was to quantify vertical motion of the arytenoid cartilage in the living subject. STUDY DESIGN: This is a prospective study. METHODS: Axial computed tomography images from 35 healthy subjects and seven patients with unilateral vocal fold paralysis were collected at inspiration and phonation. The perpendicular distance from the arytenoid vocal process (VP) or muscular process (MP) to the cricoid plane was measured and analyzed. RESULTS: During phonation, the range of the vertical movement of the VP was significantly wider than that of the MP. The vertical motion varies in sides, sexes, and ages. The vertical gaps of the VP and MP between the paralyzed and contralateral sides were about 0.8 mm and 1.5 mm, respectively. CONCLUSIONS: This study confirms a visor-like downward vertical motion of the arytenoid cartilage during phonation.

Sex Differences in Pitch Range and Speech Fundamental Frequency After Arytenoid Adduction and Thyroplasty.

OBJECTIVE: The purpose of this study was to clarify the sex differences in pitch range (PR) and speech fundamental frequency (SFF) after arytenoid adduction (AA) combined with type 1 thyroplasty (TP1) in patients with unilateral vocal fold paralysis (UVFP) and to assess the cause of these differences. STUDY DESIGN: This is a retrospective review of clinical records. METHODS: The records of 50 patients with UVFP for whom PR, SFF, and maximum phonation time (MPT) had been evaluated before and 1 year after AA combined with TP1 were analyzed. Patients consisted of 36 men and 14 women. In particular, in the 37 patients (24 men and 13 women) who had ≥2 semitones (STs) in preoperative PR (pre-PR), the differences and correlations between the pre-PR and the postoperative PR (post-PR), SFF, and MPT were compared between the sexes. We also discussed cases of post-PR deterioration and abnormal SFF. RESULTS: The characteristics of PR in men are narrow pre-PR (14.7 ± 11.5 STs) and significant extension of post-PR (22.6 ± 6.3 STs). MPT extended from 4.6 ± 2.5 seconds to 14.8 ± 7.2 seconds. In contrast, women had a wide pre-PR (18.1 ± 7.2 STs) and showed no significant post-PR extension (21.7 ± 7.8 STs). MPT extended from 5.1 ± 1.9 seconds to 16.8 ± 7.2 seconds. Although there were no significant changes in average SFF, as well as the highest and lowest pitch after the operation, the variance of the pre-SFF tended to converge into the physiological range in the post-SFF (P = 0.08). Compared with the SFF data of normal adult controls, post-SFF in the normal range was 46.0% (23/50). In patients who showed a >20% improvement in PR, normal post-SFF appeared in 68.8% of the patients (11/16). Particularly in those women, 83.3% (5/6) showed a normal post-SFF. Men showed greater difficulty in recovery of normal PR, SFF, and MPT; however, there were fewer patients (4.2%; 1/24) with a PR deterioration of >20%. Regarding women, although some patients showed a parallel recovery in PR and SFF to the normal range, there was a high rate of patients showing PR deterioration (30.8%; 4/13). CONCLUSIONS: AA combined with TP1 resulted in the recovery of not only MPT but also PR and SFF. In addition, sex differences in operative effects were suggested. In men, although MPT is difficult to be fully recovered, PR deterioration was mild. In women, although MPT was more easily extended, PR deterioration occurred more readily because of operative effects such as hypermedialization of their smaller larynx. The post-PR variation appeared to be associated with SFF. Our results indicate the necessity to assess patients' PR and SFF even if their MPTs recover, particularly in patients with postoperative voice insufficiency.

A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility.

OBJECTIVE: Comparison of different endoscopic glottis-widening procedures designed for bilateral vocal cord immobility (BVCI) is a challenge. This is because a statistically efficient analysis and comparable clinical series is hard to obtain considering the variable aspects of the results and the evaluation methods. This study of a large number of cadaver larynges provides comparable, objective data for the evaluation of the possible postoperative breathing and voicing function. STUDY DESIGN: A morphometric study was performed on 50 male and 50 female larynges to compare the different suture lateralization and resection procedures. METHODS: The postoperative characteristic of glottic configuration was evaluated following vocal cord laterofixation, endolaryngeal arytenoid abduction lateropexy (EAAL), Schobel's external lateralization procedure (SELP), transverse cordotomy (TC), and medial and total arytenoidectomies (AE). The glottic area and the parameters determining the phoniatric outcomes were assessed by a digital image analyzer program. RESULTS: Improvement of glottic area was observed after all procedures, but arytenoid abduction procedures were significantly the most effective. However, the smallest vocal cord angles were found in TC and AE; the injury of the voicing structures results in a deterioration of vocal mechanics and can be reasonably assumed to negatively influence the voice. Endolaryngeal arytenoid abduction lateropexy and SELP may provide the best phonation closure when residual adduction regeneration can occur. CONCLUSION: This study demonstrates the complexity of the correct surgical decision making in BVCI. Procedures that utilize physiological abduction of the arytenoid cartilage seem to be more advantageous, especially if recovery of adductor function occurs. LEVEL OF EVIDENCE: N/A.

Arytenoid cartilage dislocation from external blunt laryngeal trauma: evaluation and therapy without laryngeal electromyography.

BACKGROUND: Intubation trauma is the most common cause of arytenoid dislocation. The aim of this study was to investigate the diagnosis and treatment of arytenoid cartilage dislocation from external blunt laryngeal trauma in the absence of laryngeal electromyography (LEMG) and to explore the role of early attempted closed reduction in arytenoids cartilage reposition. MATERIAL AND METHODS: This 15-year retrospective study recruited 12 patients with suspected arytenoid dislocation from external blunt laryngeal trauma, who were evaluated through 7 approaches: detailed personal history, voice handicap index (VHI) test, indirect laryngoscope, flexible fiberoptic laryngoscope, video strobolaryngoscope, and/or high-resolution computed tomography (CT), and, most importantly, the outcomes after attempted closed reduction under local anesthesia. They were divided into satisfied group (n=9) and dissatisfied group (n=3) based on their satisfied with voice qualities at 1 week after the last closed reduction manipulation. RESULTS: Each patient was diagnosed with arytenoid dislocation caused by external blunt laryngeal trauma. In the satisfied group, VHI scores and maximum phonation time (MPT) at 1 week after the last reduction were significantly improved compared with those before the procedure (P<0.05). Normal or improved mobility and length of the affected vocal fold were also noted immediately after the end of the last closed reduction. The median time interval between injury and clinical intervention in satisfied group was 43.44±34.13 days, much shorter than the median time of 157.67±76.07 days in the dissatisfied group (P<0.05). CONCLUSIONS: Multimodality assessment protocols are essential for suspected arytenoid dislocation after external blunt laryngeal trauma. Early attempted closed reduction should be widely recommended, especially in health facilities without LEMG, mainly, because it could be helpful for early diagnosis and treatment of this disease. In addition, early closed reduction could also improve the success of arytenoid reduction.

Tratamiento de dos casos de enfermedad de Forestier-Rotes Querol / Treatment of two cases of Forestier-Rotes-Querol's disease

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Pediatric arytenoid dislocation: diagnosis and treatment.

Arytenoid dislocation and subluxation are well-described injuries in adults but are poorly documented in children. The most commonly cited etiology is intubation trauma although external blunt trauma also is recognized. Symptoms include dysphonia, vocal fatigue, loss of vocal control, breathiness, odynophagia, dysphagia, dyspnea, and cough. Prompt diagnosis and treatment lead to the best chance for recovery, and delayed treatment is likely to result in scarring and possibly ankylosis. The mean age of our study group was 12.3 years and consisted of six males (55%) and five females (45%). The most commonly presenting symptom was hoarseness (81.8%). Six of the 11 patients underwent surgical correction of the dislocated arytenoid cartilage. Four patients refused any treatment and one patient received voice therapy alone. Two patients who refused surgical intervention had spontaneous reduction of their dislocations. After surgical intervention, one patient regained normal voice, four patients had substantial voice improvement without return to preinjury vocal function, and one patient had only slight voice improvement. Pediatric symptoms are similar to these in adults, yet these may be less noticeable to the patient and clinician. A high index of suspicion is needed to diagnose and treat pediatric arytenoid dislocation.