Arytenoidectomy Treatment in India
Arytenoidectomy is a potentially permanent surgical procedure that widens the laryngeal inlet in its cross-section axis, providing a larger airway for respiration. Arytenoidectomy is performed in situations of bilateral vocal fold immobility triggered either by paralysis or fixation of the vocal cords.
Bilateral vocal fold paralysis (BVFP) diagnosis has progressed from external irreversible protocols to endolaryngeal laser surgery with a greater emphasis on anatomical and functional restoration. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been defined, such as partial resection processes and mucosa-saving techniques, as opposed to total arytenoidectomy. The primary outcome measure in BVFP treatment studies using full or partial arytenoidectomy is to prevent tracheotomy or decay and the reported success ranges from 90 to 100 per cent in this regard. Phonation is disrupted and arytenoidectomy deteriorates both aerodynamic and acoustic vocal characteristics.
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Recent findings suggest that partial and full arytenoidectomies have comparable findings in phonation and swallowing. We use CO2 laser-assisted partial arytenoidectomy with posteromedial mucosal flap for primary cases and set aside total arytenoidectomy for revision. Lateral suture of preserved mucosa provides friction on the vocal fold resulting in better voice and leaves no raw surgical field to unpredictable scarring or granulation.
Throughout instances of bilateral recurrent laryngeal nerve injury, the symptoms of airways often arise in addition to difficulty swallowing and change in voice quality. Patients invariably complain of shortness of breath, loss of muscle strength, and stridor. Although many of these patients may recover instantaneously without needing surgery over a year, a good percentage may require either tracheotomy to protect the airway or vocal fold suture from lateralization.
All of the above-mentioned procedures are performed in the operating theatre while the patient is under local anaesthetic. This initial report of partial arytenoidectomy under local anesthesia is consistent with the wide emerging borderline practice of laryngology commonly performed for benign and premalignant mucosal lesions.
The major benefit of laser arytenoidectomy, similar to other procedures, involves avoiding the risk of general anesthesia and morbidity associated with the suspension of micro laryngoscopy, namely tongue paraesthesia, tooth injury, and unintentional mucosal damage to pharyngeal mucosa. From the point of view of the physician, the operating field is in a neutral position and the surgical time is managed more efficiently. Arytenoidectomy remains a traditional yet sound choice in the treatment of BVFP as a permanent static procedure. Laser dissection provides for precise deconstruction in a narrow surgical field and the possibility of partial arytenoidectomy.
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