title: Videolaryngoscopic assessment of laryngeal edema after arytenoid adduction.
abstract: OBJECTIVE
  Arytenoid adduction (AA) as surgical treatment for unilateral vocal fold paralysis (UVFP) is associated with higher morbidity from airway complications due to postoperative laryngeal edema compared with other laryngeal framework surgeries. The aim of this study was to evaluate postoperative laryngeal edema after AA using a new videolaryngoscopic (VL) scoring assessment.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Nineteen patients with UVFP (14 males and five females; mean age, 56 years) who were treated with AA alone or combined with ansa cervicalis (AA/AC) nerve anastomosis or nerve-muscle pedicle (AA/NMP) flap implantation were evaluated. Laryngeal edema was assessed by VL scoring for 10 days postoperatively. Degree of edema was scored in three subsites: the membranous vocal fold, arytenoid mound, and pyriform sinus on the operated side. Statistical significance was defined as P < .05.
  
  
  RESULTS
  No patient experienced postoperative airway compromise. Interexaminer reliability was generally high (Spearman r > 0.75). The mean degree of edema increased steadily from postoperative day (POD) 1 to 3, peaking on POD 3 at all subsites. It then declined significantly from POD 3 to 7 (P < .05) and gradually through POD 10. The maximum degree of edema, maximum edema time, and operative time were not correlated significantly at any subsite. Maximum edema time and surgery type (AA vs. AA/AC or AA/NMP) were not correlated at any subsite.
  
  
  CONCLUSIONS
  Inter-rater reliability for the proposed VL scoring was significant at all subsites. The VL findings suggest that AA alone or AA combined with reinnervation showed maximum laryngeal edema on POD 3 but added no significant morbidity.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan. narajos-entmd@fc.kuh.kumamoto-u.ac.jp
authors.forename: Nena
authors.initials: N
authors.lastname: Narajos
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Toya
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kumai
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Sanuki
authors.forename: Eiji
authors.initials: E
authors.lastname: Yumoto
mesh_terms: D001193:Arytenoid Cartilage / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007819:Laryngeal Edema / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects*; D010699:Phonation / Q000502:physiology; D011183:Postoperative Complications; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014741:Video Recording; D014826:Vocal Cord Paralysis / Q000601:surgery*