Vocal fold medialization, arytenoid adduction, and partial pharyngectomy

Abstract

Multiple operative techniques have been designed to address dysphonia and dysphagia that results from unilateral vocal fold paralysis (VFP). This chapter addresses three main procedures: silastic medialization laryngoplasty, arytenoid adduction, and hypopharyngeal pharyngoplasty. Silastic medialization laryngoplasty (ML) is an excellent long-term solution for repositioning a paralyzed vocal fold near the middle to correct glottic insufficiency and minimize aspiration. In patients with unilateral VFP who have a lack of vocal process contact during phonation (large posterior gap), shortened immobile vocal fold, and those with vocal folds at different levels, Arytenoid Adduction (AA) should be considered in addition to ML. The improved posterior glottic closure afforded by an AA can result in better voice and less aspiration in select cases. For “high vagal palsy”, Hypopharyngeal Pharyngoplasty (HPPP) is a surgical procedure that can be used in conjunction with ML and AA. It tightens the paralyzed inferior constrictor and reduces the size of the pyriform sinus to limit the buildup of secretions. In addition, a cricopharyngeal (CP) myotomy in often performed in conjunction with the HPPP to facilitate opening of the CP, which often fails to relax as a result of CN X injuries.