Optimal Arytenoid Position in Laryngeal Framework Surgery: An Anatomic Human Larynx Study. 2021

Elizabeth S Burckardt, and Gerardo Lopez-Guerra, and James B Kobler, and Monica A Tynan, and Robert H Petrillo, and Jarrad H Van Stan, and James A Burns
Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.

The purpose of this study was to better understand the effects of stitch placement on arytenoid medialization by measuring normative cricoarytenoid joint anatomy and changes in arytenoid position when varying arytenopexy stitch configuration. This adult human larynx study was done in two parts. First, measurements of the cricoid and arytenoid cartilage anatomy relevant to cricoarytenoid joint function were made in 45 preserved larynges (26 male (M), 19 female (F)) using digital calipers. Second, the arytenoids of six fresh larynges ( three M, three F) were sutured to the cricoid using various arytenopexy-stitch placements ranging from inferior-lateral to superior-medial, and the resulting arytenoid positions were compared by measuring medial displacement of the arytenoid body and change in glottal configuration from macro still images using Image J. Paired t-tests were used to compare the results. Cartilage and joint facet dimensions showed differences between males (M) and females (F). Cricoid facet lengths averaged 9.3 mm (M) and 7.1 mm (F), and widths averaged 4.9 mm (M) and 4.0 mm (F). The arytenoid facet widths averaged 10.5 mm (M) and 9.7 mm (F). Average distances between cricoid facets were 11.8 mm for both males and females. Securing the arytenoid superior-medially on the cricoid facet produced more medialization (2.2 mm vs 1.0 mm, P < .001) and better glottic aperture configuration (9.5° vs 2.7°, P < .001) than securing the arytenoid inferior-laterally on the facet. Anatomic consistency in cricoarytenoid anatomy provides reliable surgical landmarks for ideal placement of an arytenopexy suture to optimally reposition the arytenoid cartilage. Optimal arytenoid medialization can be accurately reproduced with an arytenopexy-suture that is placed superior-medially on the cricoid facet. NA Laryngoscope, 131:2540-2544, 2021.

UI MeSH Term Description Entries
D008297 Male Males
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D003413 Cricoid Cartilage The small thick cartilage that forms the lower and posterior parts of the laryngeal wall. Cartilage, Cricoid,Cartilages, Cricoid,Cricoid Cartilages
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D001193 Arytenoid Cartilage One of a pair of small pyramidal cartilages that articulate with the lamina of the CRICOID CARTILAGE. The corresponding VOCAL LIGAMENT and several muscles are attached to it. Arytenoid Cartilages,Cartilage, Arytenoid,Cartilages, Arytenoid
D013536 Suture Techniques Techniques for securing together the edges of a wound, with loops of thread or similar materials (SUTURES). Suture Technics,Suture Technic,Suture Technique,Technic, Suture,Technics, Suture,Technique, Suture,Techniques, Suture
D014826 Vocal Cord Paralysis Congenital or acquired paralysis of one or both VOCAL CORDS. This condition is caused by defects in the CENTRAL NERVOUS SYSTEM, the VAGUS NERVE and branches of LARYNGEAL NERVES. Common symptoms are VOICE DISORDERS including HOARSENESS or APHONIA. Laryngeal Nerve Palsy, Recurrent,Laryngeal Paralysis,Acquired Vocal Cord Palsy,Bilateral Vocal Cord Paresis,Congenital Vocal Cord Palsy,Paralysis, Unilateral, Vocal Cord,Paralysis, Vocal Cord, Unilateral,Partial Paralysis (Paresis) Vocal Cords,Recurrent Laryngeal Nerve Palsy,Total Vocal Cord Paralysis,Unilateral Paralysis, Vocal Cord,Unilateral Vocal Cord Paralysis,Unilateral Vocal Cord Paresis,Vocal Cord Palsy,Vocal Cord Palsy, Congenital,Vocal Cord Paralysis, Unilateral,Vocal Cord Paresis,Vocal Fold Palsy,Laryngeal Paralyses,Palsies, Vocal Cord,Palsies, Vocal Fold,Palsy, Vocal Cord,Palsy, Vocal Fold,Paralyses, Laryngeal,Paralyses, Vocal Cord,Paralysis, Laryngeal,Paralysis, Vocal Cord,Pareses, Vocal Cord,Paresis, Vocal Cord,Vocal Cord Palsies,Vocal Cord Paralyses,Vocal Cord Pareses,Vocal Fold Palsies
D058753 Laryngoplasty Restoration, reconstruction, or improvement of a defective or damaged LARYNX. Medialization Laryngoplasty,Thyroplasty,Laryngoplasties,Laryngoplasties, Medialization,Laryngoplasty, Medialization,Medialization Laryngoplasties

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