title: Modifications to the Fenestration Approach for Arytenoid Adduction Under Local Anesthesia.
abstract: OBJECTIVE
  We modified the fenestration approach for arytenoid adduction to make it easier to perform the surgery. The aim of this study was to evaluate the usefulness of our modifications, which included (1) use of an Alexis wound retractor (Applied Medical) to secure the surgical field through a small incision, and (2) use of a 12-mm, 1/2 R, insert-molded taper needle with 3-0 nylon suture to prevent damage to the arytenoid cartilage.
  
  
  METHODS
  This is a retrospective non-randomized observational cross-sectional study.
  
  
  METHODS
  We compared the operative time and skin incision length between the conventional fenestration approach and our modified procedure, and verified the improvement of patients' voice by our procedure.
  
  
  RESULTS
  Seven patients underwent the conventional fenestration approach for arytenoid adduction with type I thyroplasty, whereas nine patients underwent our modified fenestration approach for arytenoid adduction with type I thyroplasty. The skin incision length with our modifications (median, 3.0 cm; interquartile range [IQR], 3.0-4.0) was significantly shorter than with the conventional procedure (median, 5.0 cm; IQR, 4.3-5.8) (P = 0.001). The operative time with our modifications (median, 95 minutes; IQR, 90-100) was significantly shorter than without our modifications (median, 115; IQR, 100-130) (P = 0.035). All patients who underwent our modified fenestration approach for arytenoid adduction had maximum phonation time greater than 11 seconds after surgery.
  
  
  CONCLUSIONS
  Our two distinctive modifications reduced the operative time and skin incision length for the fenestration approach, which improved the procedure by making it less invasive.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan. Electronic address: tfukuhara3387@med.tottori-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuhara
authors.affiliation: Center for Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Morisaki
authors.affiliation: Division of Medical Education, Department of Social Medicine, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kataoka
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Naritomo
authors.initials: N
authors.lastname: Miyake
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Kenkichiro
authors.initials: K
authors.lastname: Taira
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koyama
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Fujiwara
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kitano
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Takeuchi
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D001193:Arytenoid Cartilage / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies
keywords: Arytenoid adduction; Recurrent nerve palsy; Thyroplasty; Vocal palsy; Wound retractor