Arytenoid abduction for bilateral vocal fold paralysis

Patients with bilateral laryngeal paralysis suffer primarily from airway obstruction because the vocal folds do not abduct for inspiration. However, many patients have some adductor action during phonation, so that the voice is not severely impaired and may even be near. Surgical treatments that statically enlarge the glottis improve the airway at the expense of the voice. Arytenoid abduction (AAb) is a surgical procedure that simulates action of the posterior cricoarytenoid muscle, the only laryngeal abductor muscle. AAb externally rotates the arytenoid to move the vocal process laterally and rostrally. This increases the glottic airway for inspiration but does not abolish existing adductor action, as the axis of arytenoid rotation for abduction is significantly different than the axis for adduction. AAb involves an external approach and is technically more difficult than endoscopic procedures, such as arytenoidectomy or cordectomy. However, endoscopic procedures usually impair the voice and carry risks of stenosis and aspiration during swallowing.