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Evidence Supports Current Recommendation Regarding Suture Position in Arytenoid Adduction

by Linda Kossoff •

In performing arytenoid adduction (AA), what effect does suture position on the thyroid have on the patient’s voice production and quality?

BOTTOM LINE

Arytenoid adduction suture placed in the anterior inferior thyroid ala results in the best acoustic, aerodynamic, and voice quality outcomes.

BACKGROUND: Dysphonia due to unilateral vocal fold paralysis (UVFP) is commonly treated with surgical medialization of the vocal fold. In cases of large posterior glottal gaps, AA or AA plus medialization thyroplasty is the recommended surgical procedure. There is a range of possible AA suture positions, the voice effects of which remain unclear.

STUDY DESIGN: Animal model.

SETTING: Department of Head and Neck Surgery, University of California, Los Angeles, Calif.

SYNOPSIS: This was the first study to investigate the phonatory effects of AA suture position using a neurologically intact in vivo larynx. Surgery was performed on two male mongrel dogs, during which the larynx, recurrent laryngeal nerves (RLNs), and superior laryngeal nerves (SLNs) were exposed. To simulate all neuromuscular activation conditions possible in UVFP, RLNs and SLNs were stimulated in various combinations for each possible AA suture position. In each animal, 640 unique neuromuscular phonatory posture conditions were tested across two paralysis types, five suture positions, and eight activation levels each of the RLNs and SLNs. For each neuromuscular activation condition, researchers recorded parameters for acoustics, aerodynamic pressure, and laryngeal posture. Results of the study supported current recommendations for AA suture position in the anterior–inferior thyroid cartilage. Authors note that although the finding maintains the status quo in clinical practice, the suture position selection can now be based on scientific evidence. Study limitations included anatomical and physiological differences in canines, and the fact that researchers did not apply standardized force to each adduction suture.

CITATION: Pillutla P, Zhang Z, Chhetri DK. Effects of arytenoid adduction suture position on voice production and quality. Laryngoscope. 2021;131:846-852.