Arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway

• Published in: American journal of otolaryngology 2012-05, Vol.33 (3), p.303-307
• Main Authors: Kanazawa, Takeharu, MD, PhD, Watanabe, Yusuke, MD, PhD, Hara, Mariko, MD, Shinnabe, Akihiro, MD, Kusaka, Gen, MD, PhD, Murayama, Takanori, MD, PhD, Iino, Yukiko, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arytenoid Cartilage - surgery; Biological and medical sciences; Female; Follow-Up Studies; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Laryngeal Masks; Laryngoplasty - methods; Laryngoscopy - methods; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Otolaryngology; Otorhinolaryngology. Stomatology; Phonation - physiology; Retrospective Studies; Surgery; Treatment Outcome; Vocal Cord Paralysis - diagnosis; Vocal Cord Paralysis - physiopathology; Vocal Cord Paralysis - surgery; Voice Quality
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2011.08.008

Abstract Purpose Laryngeal framework surgery is usually performed under local anesthesia but cannot be tolerated by some patients. To develop a new procedure for these patients, we evaluated voice outcomes after arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway (LMA) for unilateral vocal cord paralysis. Materials and Methods Eleven consecutive patients with severe unilateral vocal cord paralysis, with a maximum phonation time of less than 5 seconds, underwent arytenoid adduction combined with medialization laryngoplasty under general anesthesia using an LMA. Each paralyzed vocal cord was observed by intraoperative videolaryngoscopy. The vocal cord was moved to the position where the best vocal outcome could be expected, according to 3 parameters obtained from glottal images. Results All patients achieved a maximum phonation time of more than 11 seconds. The mean airflow rate, which ranged from 550 to 1000 mL/s before surgery, improved to less than 390 mL/s. Perceptual evaluation using the grade, roughness, breathiness, asthenia and strain scale also improved significantly. Conclusions These results were equivalent to those of previous reports of surgeries performed under local anesthesia. Intraoperative endoscopic vocal cord observation through the LMA may have contributed to the positive results.