Abstract
We performed arytenoid adduction in combination with type I thyroplasty under local anesthesia for the treatment of breathy hoarseness due to unilateral vocal fold paralysis. To facilitate access to the muscular process of the arytenoid cartilage and to decrease discomfort of the patient, we sometimes removed the posteroinferior part of the thyroid ala including the inferior cornu. After that, mild rotation of the thyroid cartilage provided an operative field sufficient for reaching the muscular process. Patients underwent multi-slice computed tomographic (CT) scanning during phonation when the operation was planned. The line starting at the midpoint of the midline and parallel to the line connecting the inferior tubercle and the bottom of the midline was considered the reference line. The tip of the vocal process of the arytenoid cartilage on the healthy side was projected to the thyroid ala on the paralyzed side based on CT data. Distances of the projection from the reference line and from the midline were calculated with the aid of a CT workstation. Then, type I thyroplasty window was designed, based on these distances. After clinical use of this method, although the number of patients was small, we found that it could determine the location of the upper edge of the vocal fold during phonation. Removal of cartilage, which was often ossified, was performed utilizing an otologic drill under microscopic control.
