What is the role of surgical lateralization procedures 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 1985, Ejnell et al reported their technique for mobilizing a fixed arytenoid with subsequent lateral fixation. [11] The object of this procedure, in contrast to the previously described method, is mobilization for the express purpose of arytenoid refixation in an advantageous position. The technique is performed by using jet ventilation or through a preexisting tracheostoma with the patient under general anesthesia. Coordinated endoscopy and external work are necessary to lateralize the true vocal fold. The arytenoid is initially positioned by passing a dilator through the glottis. Concurrent external lateral fixation is then affected by passing 2 needles through the thyroid lamina to create a suture loop around the vocal fold under direct vision of the endoscopist. The suture is then tied externally over the thyroid cartilage to maintain the position.

Cummings et al described a variation of this technique in 1999. [12] Their novel device and technique attempt to provide adjustable vocal-fold lateralization with a modified thyroplasty technique performed under flexible laryngoscopic visualization. Their design localizes the height of the true vocal fold by placing an external needle through a 1-cm, round window in the thyroid cartilage. A double helical cam device is then inserted medially to engage the soft tissue of the thyroarytenoid muscle lateral to the vocal process. The double-helix design allows the now-engaged tissue to be lateralized by independently backing out the outer cam and by drawing the inner helix and the vocal cord outward into the desired position. Subsequent adjustments after healing are theoretically feasible.

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