Arytenoid adduction: Controlling vertical position

In flaccid laryngeal paralysis, the vocal process (VP) is displaced lateral ly and superiorly. The arytenoid adduction procedure (AA) moves the VP medi ally and caudally, closing the glottic gap. However, clinical evidence sugg ests that the VP is more caudal after AA than in physiological phonation. T he neurally intact arytenoid is supported by tonic and phonatory activity o f the posterior cricoarytenoid muscle (PCA). We hypothesize that a posterio r anchoring suture could replace PCA support, achieving a more natural VP l ocation. Cadaver larynges were scanned with computed tomography at rest and after AA, alone or in combination with a second arytenoid suture anchored to either the posterior midline cricoid (PC) or the inferior thyroid cornu (IC). Each posterior suture reduced caudal displace ment of the VP during A A, but the glottic gap was wider with the PC suture. In 3 patients undergoi ng AA for laryngeal paralysis, the IC suture improved arytenoid posture and voice quality.