Laryngeal rebalancing for the treatment of arytenoid dislocation

In almost every type of functional laryngeal operation a successful result hinges on the surgeon's ability to control the muscular and ligamentous forces that act upon the vocal folds. Most of the time these forces are small in relation to the manipulations and resections performed. Occasionally, the forces are significant relative to the problem encountered, resulting in a failed surgery. Of all the many conditions that fit in to this latter description, perhaps the best example in arytenoid dislocation. Dislocation of the arytenoid is usually secondary to trauma with the majority of reported cases resulting from some type of anesthetic misadventure. Two types of dislocation have been described, anteromedial and posterolateral, each with a different mechanism of causation. This paper concerns itself with the more common anteromedial variety and its treatment using botulinum toxin.