Cricothyroid subluxation: A new innovation for enhancing the voice with laryngoplastic phonosurgery

Laryngoplastic phonosurgery has evolved to become a:dominant treatment moda lity for paralytic dysphonia. Current surgical procedures have addressed pr imarily the position of the musculomembranous vocal fold and the arytenoid in the axial and vertical planes. However, dynamic range capabilities and v ocal flexibility have been limited secondary to the flaccid, denervated voc al fold tissue. Therefore, a new procedure was conceived to enhance the aco ustic vocal outcome from operations that reposition the vocal edge. Cricoth yroid (CT) subluxation was designed as a technique to increase the distance between the cricoarytenoid joint and the insertion of the anterior commiss ure ligament. Cricothyroid subluxation was done without complication in 9 p atient's who underwent combined adduction arytenopexy and medialization lar yngoplasty, and in 4 patients with medialization laryngoplasty alone. Posto perative stroboscopic assessment was done in all of the 13 patients, while complete analysis of vocal function was available in Ib of the 13 patients; this revealed improvement (as a group) on almost all objective measures ov er the preoperative state. All patients who underwent CT subluxation had a normal maximum frequency range (pitch variation of more than 2 octaves), as compared with 22% of a prior similar cohort of patients who did not underg o CT subluxation. All patients who underwent CT subluxation had normal glot tal airflow and a normal noise-to-harmonics ratio. Cricothyroid subluxation is a relatively easily adjustable procedure that increases the length and viscoelastic tension of the denervated vocal fold. The modified biomechanic al properties resulted in improved vocal outcome in all of our patients, wh ich was most remarkable in terms of maximal range capabilities, Cricothyroi d subluxation enhanced the postoperative voice of patients regardless of wh ether they required medialization laryngoplasty alone or whether they also required adduction arytenopexy.