64 Arytenoid Adduction and Abduction

Question 1

Arytenoid abduction - treatment for: ______

Arytenoid adduction - treatment for: ______

Answer 1

concept - do not memorize verbatim

Abduction: airway obstruction as a result of laryngeal paralysis

Adduction: laryngeal incompetence as result of flaccid paralysis

Question 2

How is arytenoid adduction performed?

Answer 2

concept

Placing suture in muscular process of arytenoid, passed through paraglottic space, secured to inferior thyroid ala

Question 3

Arytenoid abduction. How is it performed?

Answer 3

Suture in muscular process, then anchoring the suture near the inferior cornu of thyroid cartilage

Question 4

First surgical option for patients with unilateral laryngeal paralysis:

Answer 4

Injection laryngoplasty/medialization laryngoplasty

Arytenoid adduction is not the first choice surgical option for most patients with unilateral laryngeal paralysis.

Question 5

When do you consider arytenoid adduction in place if thyroplasty or injection laryngoplasty (in what clinical circumstance)

Answer 5

concept

“However, when the vocal process is laterally displaced, thyroplasty or injection laryngoplasty is usually inadequate to achieve glottic closure”

Arytenoid adduction for this with significant glottic incompetence

Question 6

Two key factors that influence glottal closure in patients with laryngeal paralysis:

Answer 6

Configuration of the paralyzed vocal fold

Compensatory function of the contralateral fold

Question 7

Semon Hypothesis

Answer 7

Abductor muscles damages first m - in a partial injury, they would lie close to midline with weak abduction. Over time, as nerve damage progresses, adductor muscles would weaken and vocal fold would move laterally.

Question 8

Wagner Grossman Hypothesis

Answer 8

In complete paralysis of RLN, cord lies in paramedian position because intact cricothyroid adducts the cord.

If SLN also paralyzed, paralyzed cord will assume INTERMEDIATE (cadaveric) position because of loss of adductice force.