title: Superomedial submucosal partial arytenoidectomy for improved posterior glottic closure: surgical technique and case presentation.
abstract: OBJECTIVE
  Endoscopic medial partial arytenoidectomy has been described previously for expansion of the posterior glottic airway in bilateral vocal fold paralysis. Superomedial submucosal partial arytenoidectomy (SSPA), a modification of this technique, can improve glottic closure in the setting of an obstructing anteromedially prolapsed arytenoid. We present our surgical technique and a case example.
  
  
  RESULTS
  A 45-year-old man presented with dysphonia attributable to unilateral true vocal fold paralysis. Laryngoscopy revealed right true vocal fold atrophy and an anteriorly prolapsed right arytenoid cartilage preventing posterior glottic closure during adduction. Right SSPA and ipsilateral vocal fold injection augmentation were performed without complication. One-month and 11-month postoperative evaluations showed marked improvement in voice, with complete glottic closure. Quality-of-life assessment and patient report showed a durable result at 50 months.
  
  
  CONCLUSIONS
  SSPA may be a valuable technique in the management of breathy dysphonia associated with posterior glottic gap and other sequelae of the malpositioned arytenoid.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Romak
authors.forename: Dale C
authors.initials: DC
authors.lastname: Ekbom
authors.forename: Amy M
authors.initials: AM
authors.lastname: Saleh
authors.forename: Diana M
authors.initials: DM
authors.lastname: Orbelo
authors.forename: Nicolas E
authors.initials: NE
authors.lastname: Maragos
mesh_terms: D001193:Arytenoid Cartilage / Q000601:surgery*; D005931:Glottis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000601:surgery*; D014832:Voice Disorders / Q000601:surgery
keywords: dysphonia; endoscopic arytenoidectomy; glottic closure; prolapsed arytenoid; unilateral vocal fold paralysis; voice disorder