Laryngeal Framework Surgery

Abstract

Laryngeal framework surgery is a surgical method devised and systematized by Isshiki, in which surgical operations are applied to the cartilage of the laryngeal framework according to the disease condition, without operating on the vocal folds. This is a surgery that changes the position and tension of the internal vocal folds and improves symptoms. Laryngeal framework surgery includes type I (lateral compression), type Ⅱ (lateral expansion), type Ⅲ (relaxation/shortening), type Ⅳ (stretching/lengthening), and arytenoid adduction (movement to adduction position and fixation). This time, surgical techniques for type I, arytenoid adduction, and type Ⅱ will be explained.

Type I thyroplasty : The location of the cartilage fenestration is an important point. If the position of the cartilage fenestration is closer to the cranial side, the expected effect will not be obtained. Be aware of the fenestration in the ventrocaudal position of the affected thyroid cartilage.

Arytenoid adduction : Various methods have been reported with respect to the method of identification and the direction of traction of the arytenoid cartilage. From an airway perspective, since this is a surgery that narrows the airway, care must be taken to prevent excessive adduction of the arytenoid cartilage.

Type Ⅱ thyroplasty : Although the concept of this surgery is simple, the surgical effect cannot be obtained unless the midline incision of the thyroid cartilage is made in the area where the anterior commissure tendon is attached to the thyroid cartilage. Therefore, extreme caution is required when making the cartilage incision.