A new paramedian approach to arytenoid adduction and strap muscle transposition for vocal fold medialization

Chih Ying Su, Chun Chung Lui, Hsin Ching Lin, Jeng Fen Chiu, Chu An Cheng

Research output: Contribution to journalJournal Article peer-review

30 Scopus citations


Objective: To develop a prosthesis-free medialization laryngoplasty for the treatment of glottal incompetence. Study Design: Twenty-two consecutive patients with glottal incompetence underwent vocal fold medialization using a new paramedian approach to arytenoid adduction and/or strap muscle transposition. Methods: Under local anesthesia, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. After dividing the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally, the inner perichondrium was opened, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 or 3-0 Prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium and the thyroid cartilages sutured back into place. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and maximal phonation time, as well as assessments of voice quality. Results: Vocal improvement was obtained in 95% (21 of 22) of patients. There was a significant improvement (P <.05) in all parameters except shimmer. No major complications were noted in any patient, except for dyspnea in one patient resulting from arytenoid overrotation. Conclusion: The results suggest that a paramedian approach to arytenoid adduction combined with strap muscle transposition is a safe and effective method for treating glottal incompetence, particularly in patients with unilateral paralytic dysphonia.

Original languageEnglish
Pages (from-to)342-350
Number of pages9
Issue number2
StatePublished - 2002
Externally publishedYes


  • Arytenoid adduction
  • Glottal incompetence
  • Medialization laryngoplasty
  • Paramedian approach
  • Unilateral paralytic dysphonia


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