title: Multiparameter comparison of injection laryngoplasty, medialization laryngoplasty, and arytenoid adduction in an excised larynx model.
abstract: OBJECTIVE
  Evaluate the effect of injection laryngoplasty (IL), medialization laryngoplasty (ML), and ML combined with arytenoid adduction (ML-AA) on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup.
  
  
  METHODS
  Comparative case study using ex vivo canine larynges.
  
  
  METHODS
  Measurements were recorded for eight excised canine larynges with simulated unilateral vocal fold paralysis before and after vocal fold injection with Cymetra. A second set of eight larynges was used to evaluate medialization laryngoplasty using a Silastic implant without and with arytenoid adduction.
  
  
  RESULTS
  IL and ML led to comparable decreases in phonation threshold flow (PTF), phonation threshold pressure (PTP), and phonation threshold power (PTW). ML-AA led to significant decreases in PTF (P = .008), PTP (P = .008), and PTW (P = .008). IL and ML led to approximately equal decreases in percent jitter and percent shimmer. ML-AA caused the greatest increase in signal-to-noise ratio. ML-AA discernibly decreased frequency (P = 0.059); a clear trend was not observed for IL or ML. IL significantly reduced mucosal wave amplitude (P = 0.002), whereas both ML and ML-AA increased it. All procedures significantly decreased glottal gap, with the most dramatic effects observed after ML-AA (P = 0.004).
  
  
  CONCLUSIONS
  ML-AA led to the greatest improvements in phonatory parameters. IL was comparable to ML aerodynamically and acoustically, but caused detrimental changes to the mucosal wave. Incremental improvements in parameters recorded from the same larynx were observed after ML and ML-AA. To ensure optimal acoustic outcome, the arytenoid must be correctly rotated. This study provides objective support for the combined ML-AA procedure in tolerant patients.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hoffman
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Witt
authors.forename: William J
authors.initials: WJ
authors.lastname: Chapin
authors.forename: Timothy M
authors.initials: TM
authors.lastname: McCulloch
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jiang
mesh_terms: D000818:Animals; D001193:Arytenoid Cartilage / Q000503:physiopathology / Q000601:surgery*; D004195:Disease Models, Animal; D004285:Dogs; D007267:Injections; D007820:Laryngeal Mucosa / Q000187:drug effects; D007830:Larynx / Q000601:surgery*; D010699:Phonation / Q000502:physiology*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*