Arytenoid adduction in vocal fold paralysis

Medialization laryngoplasty with Silastic (MLS) has become the mainstay of treatment for patients with unilateral vocal fold paralysis. However, a significant number of these patients undergoing MLS fail to achieve near normal voice quality, because of the fact that medialization alone often fails to adduct the arytenoid. Without adduction of the arytenoid, the vocal fold fails to achieve the physiologic phonating position. In this subset of patients, the addition of arytenoid adduction to MLS results in a significantly stronger voice and less vocal fatigue. This discussion based on over 125 patients undergoing arytenoid adduction (AA), emphasizes the surgical technique of performing AA in conjunction with MLS.