Addressing the Arytenoid in Paralytic Dysphonia Using the Adduction Arytenopexy.

Adduction arytenopexy is a surgical procedure that allows the surgeon to position the arytenoid cartilage in a vocally favorable position with a suture. It is not needed in most cases of vocal paralysis when there is favorable synkinesis and good positioning of the arytenoid body. When there is a large posterior gap (intercartilaginous region), height discrepancy, or an anteriorly displaced arytenoid, adduction arytenopexy is used to suture the arytenoid cartilage into the posterior and medial aspect of the cricoarytenoid joint facet, bringing the medial bodies of the arytenoid cartilages together allowing increased closure resulting in higher dynamic range in postoperative voices. It increases the tension in the vocal fold, allowing for improved vocal quality. Adduction arytenopexy is typically combined with medialization laryngoplasty to support the vocal fold and increase the subglottic pressure that can be achieved. Cricothyroid subluxation is performed to allow the surgeon to select the degree of tension to match the opposite, working vocal fold. When there is accumulation of secretions and food in the ipsilateral dilated pyriform sinus, a hypopharyngoplasty is added to decrease the volume of the pyriform sinus and improve swallowing.