GLOTTIC CONFIGURATION AFTER ARYTENOID ADDUCTION

It has been recently noted that laryngeal paralysis results in a compl ex alteration of the glottis. The membranous segment of the paralyzed vocal fold is shortened, and, during phonation, patients use hyperfunc tion to shorten the normal vocal fold to about the same length. Additi onally, if the paralyzed vocal fold is not near the midline, the angle between the membranous and cartilaginous segments of the vocal fold i s decreased, resulting in a ''posterior'' gap which cannot be closed b y hyperadduction of the normal side. To determine whether arytenoid ad duction addresses these problems, videolaryngoscopy was analyzed in 11 patients before and after surgery, and results were compared to patie nt satisfaction and acoustic and aerodynamic assessment. The posterior gap and glottic competence were improved in all patients, but only 6 had improvement in symptoms. Two had persistent vocal fold bowing but achieved good function after Teflon(R) injection. Three patients, all with paralysis for more than 20 years, had no increase in vocal fold l ength and very little subjective vocal improvement. Arytenoid adductio n is most effective in acute cases. Poor functional results in chronic paralysis are related to failure to achieve vocal fold lengthening, p resumably due to soft-tissue contracture.