title: A "fenestration approach" for arytenoid adduction through the thyroid ala combined with type I thyroplasty.
abstract: OBJECTIVE
  To develop and evaluate the voice outcomes of an approach of arytenoid adduction (AA) through a fenestration of the thyroid ala for unilateral vocal cord paralysis.
  
  
  METHODS
  Twelve consecutive patients with severe unilateral vocal cord paralysis, whose maximum phonation times (MPTs) were less than or equal to 5 seconds, underwent laryngoplasty using an approach of AA performed through a fenestration of the thyroid ala combined with type I thyroplasty.
  
  
  METHODS
  Two surgical windows were made in the lower part of the thyroid ala. The anterior window was for typical type I thyroplasty, and the posterior window was for AA. AA was performed by pulling the lateral cricoarytenoid muscle (LCA) (5 patients) or muscular process (7 patients) through the posterior fenestration in the contractile direction of the LCA without releasing the cricoarytenoid joint. The operation was performed under local anesthesia with sedation except in two patients who underwent general anesthesia using a laryngeal mask. The vocal cord medialization was confirmed endoscopically during the operation. For all patients, the MPT and mean airflow rate (MFR) were measured before and after the operation. The postoperative voices were analyzed using shimmer and jitter.
  
  
  RESULTS
  All patients achieved a MPT of over 12 seconds. The MFR, which ranged from 340 to 1902 mL/second before the operation, improved to less than 200 mL/second, except in one patient whose MFR was 210 mL/second. Shimmer and jitter improved significantly after the operation. Perceptual evaluation using the GRBAS (grade, roughness, breathiness, aesthenia, strain) scale also improved significantly.
  
  
  CONCLUSIONS
  A fenestration-based approach simplified the combination of AA and type I thyroplasty because the two treatments could be performed in the same operating field and provided good voice improvement. Pulling the AA braid in the contractile direction of the LCA and endoscopic vocal cord observation during surgery may have contributed to the positive results.
authors: Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan. tokachanman@aol.com
authors: Ryoji
authors: R
authors: Tokashiki
authors: Hiroyuki
authors: H
authors: Hiramatsu
authors: Kiyoaki
authors: K
authors: Tsukahara
authors: Hidenori
authors: H
authors: Kanebayashi
authors: Mari
authors: M
authors: Nakamura
authors: Rei
authors: R
authors: Motohashi
authors: Tetsuya
authors: T
authors: Yamada
authors: Mamoru
authors: M
authors: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001193:Arytenoid Cartilage / Q000294:innervation*; D005260:Female; D006801:Humans; D008297:Male; D009334:Neck Muscles / Q000294:innervation*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010699:Phonation; D013961:Thyroid Gland / Q000601:surgery*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000503:physiopathology* / Q000601:surgery*; D014833:Voice Quality