Sling arytenoid adduction

The purpose of this study was to describe a simplified arytenoid rotation technique and to test its applicability in excised human larynges. A non-absorbable monofilament thread is slung around the muscular process of the arytenoid cartilage through an external approach. During visual control through flexible endoscopy, two needles and a wire loop needle threader are the only instruments needed. Thread tensioning and fixation results in a stabilized arytenoid adduction. This technique avoids cricothyroid joint disarticulation and leaves the thyroid cartilage intact. The practicability of the technique was proven in five excised larynx experiments. In two clinical cases, the muscular process was slung and pulled with a monofilament thread. Tension in the vector direction parallel to the LCA muscle showed an effective and stable arytenoid rotation with complete closure of the posterior glottis. The rotational effect following sling arytenoid adduction (SAA) is similar to conventional arytenoid adduction surgery outcome. However, SAA is performed from an external approach and avoids dissection of cartilage. Challenging dissections to reach the muscular process are avoided. In some cases of unilateral vocal fold immobility, arytenoid rotation may be performed by using the SAA technique, which allows for an external and extralaryngeal approach. Further studies should assess the clinical value of this technique. In principal, the wire loop needle threader can also be employed for external vocal fold lateralization procedures.