Glottic closure patterns: type I thyroplasty versus type I thyroplasty with arytenoid adduction.

Area of Science:

• Otolaryngology
• Laryngology
• Speech Science

Background:

• Unilateral vocal fold paralysis often necessitates laryngeal framework surgery to improve glottic closure.
• Type I thyroplasty (Th) and arytenoid adduction (AA) are common surgical interventions.
• AA is often performed to address posterior glottic closure and vertical height discrepancies.

Purpose of the Study:

• To compare the effectiveness of Type I thyroplasty (Th) with and without arytenoid adduction (AA) in improving posterior glottic closure and vertical height equality.
• To evaluate if the addition of AA to Th offers superior outcomes in specific geometric parameters of the glottis.

Main Methods:

• Retrospective analysis of videostroboscopic examinations from 45 patients with unilateral vocal fold paralysis.
• Pre- and postoperative evaluations were conducted.
• Three blinded reviewers assessed glottic closure patterns using visual analog scales.

Main Results:

• No statistically significant differences were found between Th alone and Th with AA for midmembranous glottic closure (P=0.282).
• Similarly, no significant differences were observed in closure anterior to the vocal processes (P=0.426), respiratory glottis closure (P=0.158), or vertical height discrepancy (P=0.113).

Conclusions:

• The addition of arytenoid adduction to Type I thyroplasty does not appear to offer significant geometric advantages in glottic closure or vertical height correction.
• Surgeons should consider that the perceived need for AA based on glottic gaps or height discrepancies may not always correlate with improved functional outcomes.
• Surgical decision-making for unilateral vocal fold paralysis should prioritize voice improvement over purely geometric considerations.