Voice Outcome following Arytenoid Adduction Combined with Two Different Procedures in the Management of Unilateral Vocal Fold Paralysis

Abstract

Objective: Glottal closure and symmetrical thyroarytenoid stiffness are two important functional characteristics of normal phonatory configuration. In the treatment of unilateral vocal fold paralysis, vocal fold adduction improves closure, facilitating entrainment of both vocal folds for improved phonation. In addition, reinnervation is purported to maintain vocal fold bulk and stiffness. A combination of adduction and reinnervation would therefore be expected to improve vocal function better than adduction alone or a combination of adduction with medialization.
Methods: A retrospective review was undertaken of pre- and postoperative voice analysis in all patients who underwent arytenoid adduction alone (adduction group) or arytenoid adduction combined with type I thyroplasty (adduction combined with thyroplasty group) or arytenoid adduction combined with ansa cervicalis to recurrent laryngeal nerve anastomosis (adduction combined with ansa group) between September 1999 and June 2008 for the treatment of unilateral vocal cord paralysis. Aerodynamic and acoustic analyses were performed preoperatively and at intervals of 1, 6, and 12 months postoperatively. Maximum phonation time (MPT) and mean airflow rate during easy phonation (MFR) were measured. Jitter, shimmer, harmonics-to-noise ratio and voice profile were also measured.
Results: There were 5 patients in the adduction group, 10 in the adduction combined with thyroplasty group and 10 in the adduction combined with ansa group. Statistically significant improvements in MPT and MFR were observed. In the adduction with thyroplasty group and the ansa group, all parameters of acoustic analysis were significantly improved after the surgery. In the adduction group, no significant change was observed in acoustic analysis at 6 and 12 months postoperatively.
Conclusions: The potential benefits of improved phonatory function following type I thyroplasty or ansa cervicalis to recurrent laryngeal nerve anastomosis with arytenoid adduction were observed.