Adduction arytenopexy, hypopharyngoplasty, medialization laryngoplasty, and cricothyroid subluxation for the treatment of paralytic dysphonia and dysphagia

Vocal fold paralysis is a common disorder of variable etiology. The resultant dysphonia and dysphagia can result in significant morbidity and decreased quality of life for the afflicted patient. Numerous surgical procedures have been developed to improve voice and swallowing, each with its own set of advantages and disadvantages. Selection of the most appropriate procedure is determined in part an assessment of the position of the arytenoid cartilage, as proper realignment of vocal fold height and length may be critical to restoration of phonatory function. While arytenoid adduction has been employed traditionally to address arytenoid position, adduction arytenopexy coupled with cricothyroid subluxation may provide enhanced aerodynamic efficiency compared to arytenoid adduction. Hypopharyngoplasty can be easily performed concurrently, which through plication of the flaccid and non-functional ipsilateral pyriform sinus, can provide significant improvement in the salivary pooling and dysphagia which often accompanies recurrent laryngeal nerve dysfunction. This paper will address the indications, advantages, and surgical technique of adduction arytenopexy, cricothyroid subluxation, and hypopharyngoplasty.