A Device that Allows an Operator to Perform Arytenoid Adduction without Assistance

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  • Nakamura Kazuhiro
    Department of Head & Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Tsukahara Kiyoaki
    Department of Head & Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Yoshida Tomoyuki
    Department of Head & Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Inagaki Taro
    Department of Head & Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Shimizu Masaaki
    Department of Head & Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Toyomura Fumimasa
    Department of Head & Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Okada Takuro
    Department of Head & Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Suzuki Mamoru
    Department of Otorhinolaryngology, Tokyo Medical University

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Other Title
  • 披裂軟骨内転術を術者単独で施行するための手術手技と器具の工夫
  • ヒレツナンコツ ナイテンジュツ オ ジュツシャ タンドク デ シコウ スル タメ ノ シュジュツ シュギ ト キグ ノ クフウ

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Abstract

Arytenoid adduction (AA) is a moderately difficult operation, and for the reason it is difficult for an operator to perform the operation alone. By contrast, an operator can perform vocal fold injection surgery under general anesthesia without assistance. However, for cases with a wide glottal slit, there is a limit to the voice improvement that can be achieved by injection surgery. Therefore, AA should be the procedure of choice when an assistant is available for the surgery. We devised a surgical procedure that would allow an operator to perform AA without assistance, and we compared the results between single-operator and multiple-operator groups.<br>From January 2001 to June 2009, 23 patients underwent AA at our department. Of the 23, 16 underwent type I thyroplasty (TPI) and/or type IV thyroplasty (TPIV) combined with AA. The average age of the patients was 60.4 years. Of the 16 patients, 13 underwent AA+TPI, 2 underwent AA+TPI+TPIV, and 1 underwent AA+TPIV. There were 6 cases in the single-operator group and 10 cases in the multiple-operator group. Total intravenous anesthesia was selected for 14 cases, and local anesthesia for 2 cases. Skin hooks and an ecarteur were used to secure the operation field, and the vessel sealing system and ultrasonically activated scalpel were used in the single-operator group. Under voice monitoring, the position of the vocal fold was determined with a laryngeal video-endoscope by the operator working alone. In the multiple-operator group, the first assistant held the laryngeal video-endoscope. We comparatively evaluated the operation time in the two groups.<br>The operation time was 130.7 minutes, on average, in the multiple-operator group and 138.0 minutes, on average, in the single-operator group ; i.e., there was no significant difference between the two groups.<br>AA can be performed by a single operator without any extension of the operation time using special devices.

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