What is the role of endoscopic arytenoid lateropexy 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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Answer

More recently, Rovo et al (2008) have described endoscopic arytenoid lateropexy for severe posterior glottic stenosis involving one or both cricoarytenoid joints. [13] This novel technique employs a specially designed, right-angled scythe for sharp division of the arytenoid and cricoid cartilage. Once scar lysis and cricoarytenoid (CA) joint mobility are achieved, a modified, steel sheath reinforced Lichtenberger endo-extralaryngeal needle carrier is used place a suture through the vocal process. The needle is then passed through the posterior aspect of the thyroid cartilage and secured through a small (about 0.5cm) transcervical incision.

When complete, the arytenoid is in a posterior, lateral, and superior position which is felt to be a more physiologic position for the abducted arytenoid than prior lateralization techniques. This procedure is temporary and is intended to keep the posterior commissure tissues apart following CO2 laser lysis. Sutures are removed once re-epithelialization is complete. The authors demonstrate improvements in peak inspiratory flow, breathing at rest, and voice (once sutures were removed) in a large majority of patients. Additionally, radiographic evidence of transient postoperative aspiration resolved completely a few weeks after surgery.


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