Correction of Arytenoid Malrotation with Non-Selective Reinnervation for Unilateral Vocal Cord Palsy: A Functional...

Unilateral vocal fold paralysis (UVFP) causes denervation of intrinsic laryngeal muscles in varying degrees and results in different types of glottal configurations. While the primary goal of surgery is to improve vocal function, outcomes are strongly influenced by how effectively the underlying laryngeal physiology and alignment are restored. Denervation of the posterior cricoarytenoid (PCA) muscle causes the arytenoid to fall anteriorly and medially. Static procedures such as medialization thyroplasty does not address this. This study evaluates the impact of non-selective laryngeal reinnervation (LR) on arytenoid position and vocal function.

A retrospective study was conducted on 41 patients with UVFP who underwent Non selective reinnervation between 2021 and 2024 at a tertiary care hospital. Arytenoid prolapse was graded using a 3-point scale from laryngoscopy videos pre- and 6 months post-operatively. Voice outcomes were assessed using Maximum Phonation Duration (MPD) and Voice Handicap Index-10 (VHI-10).

Improvement in arytenoid position was defined as an upgrade by at least one grade in the prolapse grading system.70.7% of the patients showed improvement in arytenoid position 6 months post non selective reinnervation surgery. Significant postoperative improvements were observed in both MPD and VHI-10 scores (P < 0.01), correlating with arytenoid stabilization and improved phonatory function.

Non-selective reinnervation not only improves vocal quality but also restores arytenoid position, addressing a key component of glottic insufficiency in UVFP. These findings support reinnervation as a physiologic, durable solution with functional and anatomic advantages over static medialization.