Transoral arytenoid adduction with minimal cervical incision.

INTRODUCTION Arytenoid adduction (AA) is a type of approximation laryngoplasty for unilateral vocal-fold paralysis (UVFP) patients that was firstly introduced by Morrison in 1948. The main mechanism for this procedure is vocal fold repositioning by means of pulling the muscular process of the arytenoid cartilage in the direction of the lateral cricoarytenoid (LCA) muscle. AA is especially useful when there is a large posterior glottal gap, vocal fold level difference, or severely foreshortened vocal fold; it can compensate for the limitation of type I thyroplasty. The most common AA technique currently in use was established by Isshiki. This conventional method requires making a 4-cmto 5-cm-long skin incision and cutting the inferior pharyngeal constrictor muscle to approach the posterior edge of the thyroid cartilage. Furthermore, to locate and manipulate the muscular process, excessive rotation of the larynx and dislocation of the cricothyroid (CT) joint or a partial resection of the posterior edge of the thyroid cartilage is sometimes necessary. These may result not only in cosmetic problems but also airway or swallowing dysfunctions. There have been some reports of transthyroidal/anterior approaches or transoral endoscopic methods of AA focused on the low level of invasiveness and enhanced feasibility as compared to conventional AA. However, all of these methods have been performed on cadaveric or extirpated larynges and still remain experimental. Here, we introduce a novel surgical procedure, transoral AA with a minimal cervical incision, which decreases the invasiveness of the AA procedure.