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Arytenoid asymmetry: Is it the most predictive parameter for arytenoid adduction in unilateral vocal fold paralysis?

Published online by Cambridge University Press:  17 February 2021

J R Menon ,
A S Mathew  and
S Nath
J R Menon
Affiliation:
Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, India
A S Mathew*
Affiliation:
Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, India
S Nath
Affiliation:
Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Trivandrum, India
*
Author for correspondence: Dr Amrita Suzanne Mathew, Department of Laryngology, Dr Jayakumar's Institute of Laryngology, Medical College Kumarapuram Road, Trivandrum695011, Kerala, India E-mail: amritasmathew@gmail.com
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Abstract

Objective

The aim of this study was to establish arytenoid asymmetry as a pre-operative predictive parameter for arytenoid adduction surgery in unilateral vocal fold paralysis and thereafter identify the most predictive parameter for arytenoid adduction among the established parameters.

Methods

A retrospective comparative study was undertaken. The ‘arytenoid asymmetry angle’ formed between skewed ‘glottic’ and ‘interarytenoid’ axes (traced along the plane of closure of the membranous and cartilaginous glottis, respectively) was quantified in pre-operative laryngoscopic images of 85 adults with unilateral vocal fold paralysis who underwent either type 1 thyroplasty (group 1) or type 1 thyroplasty with arytenoid adduction (group 2). The need for arytenoid adduction was determined intra-operatively based on subjective voice improvement and laryngoscopic results.

Results

Arytenoid asymmetry (p < 0.0001), posterior phonatory gap (p = 0.001) and vertical level difference (p = 0.004) were significantly greater in group 2 (descending order of parameters). Arytenoid asymmetry angle showed a significant positive correlation with the latter two parameters.

Conclusion

Arytenoid asymmetry is the most predictive parameter for arytenoid adduction. An arytenoid asymmetry angle of more than or equal to 33.9⁰ is an indication for arytenoid adduction. This aids in pre-operative planning of arytenoid adduction.

Keywords

Arytenoid CartilageLaryngeal MusclesVocal Cord ParalysisLaryngoplastyLaryngoscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 2 , February 2021 , pp. 159 - 167
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr A S Mathew takes responsibility for the integrity of the content of the paper

Presented at Phonocon, the Annual Meeting of the Association of Phonosurgeons of India, 29 February 2020, Daman, India.

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