Which mobilizing surgical procedures are performed in the treatment of cricoarytenoid (CA) fixation?

Updated: Jul 27, 2021
  • Author: Paul C Bryson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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In 1986, Schaefer et al described a surgical procedure for mobilizing fixed cricoarytenoid (CA) joints. [7] This procedure was performed through a midline thyrotomy in which a superiorly based mucosal flap was elevated from the arytenoid and posterior commissure mucosa. The medial aspect of the cricoarytenoid (CA) joint was then explored, and adhesions in the joint space were lysed until the arytenoid was thought to gain passive mobility. The posterior glottis was expanded by advancing the mucosal flap. Finally, a modified endotracheal tube (Portex stent; Smiths Medical, Kent, United Kingdom) was secured in the glottis to temporarily support the arytenoids in a lateralized position; it was removed approximately 2-3 weeks after surgery during a brief endoscopic procedure.

This procedure was performed in 4 patients, and the cannula was later removed in 3. The authors strongly believed that early postoperative speech therapy improved the range of motion of the cricoarytenoid (CA) joint and, consequently, the final functional outcome.

Closed reduction can be effectively used to treat arytenoid dislocation, according to a prospective study by Lee et al, with early surgical intervention improving outcomes of this procedure. The study involved 22 patients with arytenoid dislocation, including 16 with anterior dislocation and 6 with posterior dislocation. Patients were treated with closed reduction with or without adjunct therapy (injection laryngoplasty or botulinum toxin administration), with the exception of one patient who recovered spontaneously. Of the treated patients, 18 regained arytenoid motion, accompanied by voice improvement, with recovery sustained 6 months postsurgery. The investigators also found that patients who underwent closed reduction within 21 days after the presumed dislocation event tended to have better restoration of arytenoid motion. [8]

A study by Cao et al found that 26 out of 33 patients with an arytenoid dislocation were satisfied with the outcome following closed reduction performed under local anesthesia, with significant improvements found in grade, roughness, breathiness, asthenia, maximum phonation time, self-assessed Voice Handicap Index, jitter%, shimmer%, normalized noise energy, and noise-to-harmonic ratio. [9]

Su et al reported that three patients with bilateral vocal fold immobility and mechanical fixation of the cricoarytenoid (CA) joint were successfully treated first with release of the joint via an external approach and then with exo-endolaryngeal suture lateralization. The joint-release procedure permitted the endolaryngeal mucous membrane to be preserved and allowed one patient to be decannulated and two individuals to experience dyspnea improvement. [10]

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