title: A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility.
abstract: OBJECTIVE
  Comparison of different endoscopic glottis-widening procedures designed for bilateral vocal cord immobility (BVCI) is a challenge. This is because a statistically efficient analysis and comparable clinical series is hard to obtain considering the variable aspects of the results and the evaluation methods. This study of a large number of cadaver larynges provides comparable, objective data for the evaluation of the possible postoperative breathing and voicing function.
  
  
  METHODS
  A morphometric study was performed on 50 male and 50 female larynges to compare the different suture lateralization and resection procedures.
  
  
  METHODS
  The postoperative characteristic of glottic configuration was evaluated following vocal cord laterofixation, endolaryngeal arytenoid abduction lateropexy (EAAL), Schobel's external lateralization procedure (SELP), transverse cordotomy (TC), and medial and total arytenoidectomies (AE). The glottic area and the parameters determining the phoniatric outcomes were assessed by a digital image analyzer program.
  
  
  RESULTS
  Improvement of glottic area was observed after all procedures, but arytenoid abduction procedures were significantly the most effective. However, the smallest vocal cord angles were found in TC and AE; the injury of the voicing structures results in a deterioration of vocal mechanics and can be reasonably assumed to negatively influence the voice. Endolaryngeal arytenoid abduction lateropexy and SELP may provide the best phonation closure when residual adduction regeneration can occur.
  
  
  CONCLUSIONS
  This study demonstrates the complexity of the correct surgical decision making in BVCI. Procedures that utilize physiological abduction of the arytenoid cartilage seem to be more advantageous, especially if recovery of adductor function occurs.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Szakács
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Sztanó
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.
authors.forename: Vera
authors.initials: V
authors.lastname: Matievics
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.
authors.forename: Zsófia
authors.initials: Z
authors.lastname: Bere
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.
authors.forename: Adam
authors.initials: A
authors.lastname: Bach
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Castellanos
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Rovó
mesh_terms: D000328:Adult; D001193:Arytenoid Cartilage / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005931:Glottis / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D020127:Recovery of Function / Q000502:physiology; D013536:Suture Techniques; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000601:surgery*; D014831:Voice / Q000502:physiology
keywords: Arytenoid abduction lateropexy; arytenoidectomy; bilateral vocal cord immobility; bilateral vocal cord motion impairment; endoscopic laryngeal microsurgery; glottis-enlarging procedures; transverse cordotomy; vocal cord paralysis; vocal cord suture lateralization