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. 2020 Apr;40(2):99-105.
doi: 10.14639/0392-100X-N0183.

Modified Isshiki's arytenoid adduction without separating cricothyroid and cricoarytenoid joints

Eiji Yumoto  1   2 , Tetsuji Sanuki  3 , Yoshihiko Kumai  2 , Narihiro Kodama  2   4
Affiliations

Modified Isshiki's arytenoid adduction without separating cricothyroid and cricoarytenoid joints

Eiji Yumoto et al. Acta Otorhinolaryngol Ital. 2020 Apr.

Abstract

Intervento di adduzione aritenoidea sec. Isshiki modificata, senza separazione cricotiroidea e cricoaritenoidea.

Riassunto: Gli interventi modificati di adduzione aritenoidea (AA) sono finalizzati a preservare l’integrità dell’articolazione cricotiroidea. Non ci sono tuttavia studi comparativi che confrontino tali metodiche con interventi in cui vi sia la separazione cricotiroidea in termini di edema laringeo postoperatorio e funzione fonatoria a lungo termine. In questo studio si valuta un intervento di AA con allestimento di lembo peduncolato neuromuscolare (+ NMP) e preservazione dell’articolazione cricotiroidea. Sono stati valutati otto pazienti con paresi cordale monolaterale sottoposti a tale procedura (Gruppo 1). È stato valutato l’edema post operatorio a livello delle corde vocali, cappucci aritenoidei e seni piriformi con una scala, da 0 a 3 (0: nessun edema - 3: edema grave). Il gruppo controllo (Gruppo 2) è rappresentato da 19 pazienti sottoposti a AA con separazione dell’articolazione cricotiroidea. Il tempo massimo di fonazione (MPT), il jitter e il voice hadicap index (VHI) sono stati misurati prima e 1 anno dopo la chirurgia. I risultati funzionali fonatori del Gruppo 1 sono stati comparati con quelli di un gruppo controllo formato da 58 pazienti sottoposti a AA + NMP (Gruppo 3). L’edema a livello delle corde vocali, cappucci aritenoidei e seni piriformi del Gruppo 1 è risultato relativamente stabile dal primo al sesto giorno post operatorio. L’edema a livello delle corde vocali e seni piriformi nel Gruppo 1, a 3 e 4 giorni dalla chirurgia è risultato inferiore rispetto al Gruppo 2. Ad un anno dopo la chirurgia, non sono risultate differenze in termini di MPT, Jitter e VHI fra il Gruppo 1 e il Gruppo 3. La preservazione dell’articolazione cricotiroidea può risultare vantaggiosa nel ridurre l’edema laringeo post operatorio dopo AA. La funzione vocale dopo AA + NMP con preservazione o separazione dell’articolazione cricotiroidea sono comparabili.

Keywords: location of the muscular process; modified arytenoid adduction; postoperative oedema; preservation of the cricothyroid and cricoarytenoid joints; vocal function.

Plain language summary

Modified methods of arytenoid adduction (AA) have been reported to keep the cricothyroid (CT) joint intact. However, postoperative laryngeal oedema and long-term vocal function have not been compared with those after AA with CT joint separation. We refined AA to combine it with nerve-muscle pedicle (NMP) flap transfer for preservation of the CT joint. Eight patients with unilateral laryngeal paralysis underwent the procedure (Group 1). Postoperative oedema at membranous vocal fold (MVF), arytenoid mound (AM) and pyriform sinus (PS) was assessed using a 4-point ordinal scale: none (0) to severe (3). Laryngeal oedema in Group 1 was compared with that of 19 patients who had AA with CT joint separation (Group 2). Maximum phonation time (MPT), jitter and voice handicap index-10 (VHI-10) were measured before surgery and one year postoperatively. Vocal function in Group 1 was compared with 58 patients who underwent AA + NMP flap transfer with CT joint separation (Group 3). The degree of oedema from postoperative days 1 to 6 in Group 1 was relatively invariable: 1.2~1.6 at MVF, 1.3~1.7 at AM, and 1.4~1.7 at PS. The scores at 3 and 4 days postoperatively at MVF and PS in Group 1 were significantly lower than in Group 2 (P = 0.0032 and 0.0317 at day 3, and 0.0224 and 0.0182, at day 4, respectively). The degree of oedema at day 3 at AM in Group 1 was significantly less than in Group 2 (P = 0.0260). One year after surgery, there were no significant differences in MPT, jitter and VHI-10 between Groups 1 and 3 (P = 0.660, 0.111 and 0.556, respectively). Preservation of the CT joint might be beneficial in reducing the maximum degree of laryngeal oedema after AA. Vocal function after AA + NMP flap transfer with CT joint preservation is comparable to that after AA + NMP flap transfer with CT joint separation.

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Figures

Figure 1.
Figure 1.
Surgical approach to locate the muscular process of the arytenoid (right side). Left: after separating the cricothyroid (CT) joint and thyrohyoid ligament, the thyroid lamina is rotated anteriorly as a whole to open the paraglottic space for location of the muscular process. Right: the CT joint is not separated. Following separation of the thyrohyoid ligament, the pyriform sinus (PS) mucosa and inner perichondrium are elevated from the superior cornu and thyroid ala. Next, the cranial side of the thyroid ala is rotated anteriorly to locate the muscular process.
Figure 2.
Figure 2.
Time course of laryngeal oedema at each subsite following AA with the CT joint preserved (Group 1, continuous line) and following AA with the CT joint separated (Group 2, dotted line), as reported in our previous paper (from Narajos et al., 2012 ).
Figure 3.
Figure 3.
Changes in MPT, jitter and VHI-10 before surgery and one year after surgery in Group 1 (AA + NMP transfer with the CT joint preserved) and Group 3 (AA + NMP transfer with the CT joint separated). Dotted bars represent measurements in Group 1 and oblique-lined bars represent measurements in Group 3. The number in a bar shows the mean value of each parameter.
Figure 4.
Figure 4.
Distribution of the six intralaryngeal branches of the superior laryngeal artery (from Iimura et al., 2004 ).
See this image and copyright information in PMC

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