title: Features of Vocal Fold Adductor Paralysis and the Management of Posterior Muscle in Thyroplasty.
abstract: OBJECTIVE
  To present the pathologic characteristics of unilateral recurrent nerve adductor branch paralysis (AdBP), and to investigate the management of posterior cricoarytenoid (PCA) muscle on the basis of our experience of surgical treatment for AdBP.
  
  
  METHODS
  This is a retrospective review of clinical records
  
  
  METHODS
  Four cases of AdBP, in which surgical treatment was performed, are presented. AdBP shows disorders of vocal fold adduction because of paralysis of the thyroarytenoid and lateral cricoarytenoid muscles. The PCA muscle, dominated by the recurrent nerve PCA muscle branch, does not show paralysis. Thus, this type of partial recurrent nerve paresis retains the abductive function and is difficult to distinguish from arytenoid cartilage dislocation because of their similar endoscopic findings. The features include acute onset, and all cases were idiopathic etiology. Thyroarytenoid muscle paralysis was determined by electromyography and stroboscopic findings. The adduction and abduction of paralytic arytenoids were evaluated from 3 dimensional computed tomography (3DCT).
  
  
  RESULTS
  In all cases, surgical treatments were arytenoid adduction combined with thyroplasty. When we adducted the arytenoid cartilage during inspiration, strong resistance was observed. In the two cases where we could cut the PCA muscle sufficiently, the maximum phonation time was improved to ≥30 seconds after surgery, from 2 to 3 seconds preoperatively, providing good postoperative voices. In contrast, in the two cases of insufficient resection, the surgical outcomes were poorer.
  
  
  CONCLUSIONS
  Because the preoperative voice in AdBP patients is typically very coarse, surgical treatment is needed, as well as ordinary recurrent nerve paralysis. In our experience, adequate PCA muscle resection might be helpful in surgical treatment of AdBP.
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan. Electronic address: ujimotokn@hotmail.com.
authors.forename: Ujimoto
authors.initials: U
authors.lastname: Konomi
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan; Shinjuku Voice Clinic, Tokyo, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Tokashiki
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan; Hiramatsu ENT Clinic, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hiramatsu
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Ray
authors.initials: R
authors.lastname: Motohashi
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Sakurai
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Fumimasa
authors.initials: F
authors.lastname: Toyomura
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Nomoto
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Kawada
authors.affiliation: Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D001193:Arytenoid Cartilage / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D004576:Electromyography; D006801:Humans; D021621:Imaging, Three-Dimensional; D007821:Laryngeal Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058753:Laryngoplasty; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010699:Phonation; D011857:Radiographic Image Interpretation, Computer-Assisted; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014827:Vocal Cords / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality
keywords: 3DCT; Adductor branch paralysis; Arytenoid adduction; Posterior cricoarytenoid muscle; Recurrent nerve paresis; Thyroplasty