arytenoid adduction

The sacral cartilage adduction was first reported by Isshiki et al (1978) in the treatment of 5 patients with unilateral vocal cord paralysis, 2 of whom had hoarseness after type I thyroid cartilage. Five patients had normal vocalization after surgery. The operation has surgery under local anesthesia, the operation is simple and safe, and the degree of vocal cord adduction can be adjusted according to the vocalization condition, and is particularly suitable for cases in which the glottal width is widened or the sides of the sacral cartilage are asymmetrical. However, 1 may have difficulty in determining the position of the myo process, and the operation time is also long, but it is not difficult if it is mastered. 2 bow-shaped vocal cords are not effective after surgery, can be combined with type I thyroid cartilage. Treating diseases: vocal cord polyps Indication The iliac cartilage adduction is suitable for: 1. Unilateral recurrent laryngeal nerve palsy, breathing sound when vocalization, especially if the glottic fissure is too large or the vocal cord is fixed in the outreach position. 2. X-ray film shows that the vocal cord position of the paralyzed side should be higher than the healthy side, instead of type I thyroid cartilage. Surgical procedure 1. Position and skin incision In the supine position, the head is biased to the opposite side and the neck is straight. The horizontal incision was made on the plane corresponding to the vocal cords, and the scaly cartilage incision was further cut 1 to 2 cm posteriorly, and the skin, subcutaneous tissue, and platysma were cut. 2. Exposing the thyroid cartilage wing In order to expose the posterior margin of the thyroid cartilage wing, the sternum of the sternum is cut off. The posterior margin of the thyroid cartilage was pulled forward with a small hook, the inferior pharyngeal muscle was cut at the posterior margin of the proximal thyroid cartilage, and the perichondrium was cut, and the inferior pharyngeal muscle was separated along the incision to the posterior edge of the thyroid cartilage. 3. Separate the ring joint The inner perichondrium is sharply separated at the posterior edge of the thyroid cartilage, and the ring arm joint is separated downward. If the ring arm joint is too low, the thyroid cartilage can be cut to avoid excessive damage. In some male patients, the thyroid cartilage wing is too wide, and the posterior margin of 1cm thyroid cartilage can be removed longitudinally. Cut the upper corner of the thyroid cartilage to make the throat twist to the opposite side. Cutting the ring armor joint with scissors, the ring joint surface is an important sign to distinguish the ankle joint. 4. Find the sacral cartilage muscle process Pull up the trailing edge of the thyroid cartilage and determine the location of the muscle process. Because the position of the myo process is more concealed, there are four methods for determination: 1 the myofs and the vocal cords are in the same plane, and the projection point of the vocal cords on the thyroid cartilage wings extends backwards to the tendon cartilage muscles, and the muscles are from the upper edge of the ring armor. Less than 1cm, 3 muscles are located on the upper edge of the cartilage. When separating the muscle processes, the cartilage should be touched deep, otherwise it may enter the airway; 4 the operator touches the fingertips to touch the rice grain size protrusions, to the protrusion It can be separated to the sacral cartilage. The mucous membrane of the pear-shaped fossa is lower than the muscle process, and the mucous membrane of the piriform fossa is separated upward to separate from the posterior iliac crest muscle, and the muscle process is probed upward from the ring armor joint. 5. Open the ankle joint With a small curved scissors, cut the ankle joint and cut off some of the posterior iliac crest muscle. Use a 4-0 or 3-0 nylon thread to penetrate through the articular surface, including the proper amount of muscle and cartilage, so that the suture can withstand long-term tension. If the first needle is not strong enough, the second needle can be sewn in the same area. When the second needle is sewn, the first stitch is pulled outward to make the second needle deeper and the tissue to pass through is more. Then remove the first stitch and ligature the second stitch. 6. Suture through the thyroid cartilage The suture attached to the musculature is fixed through the thyroid cartilage and two holes are required to be placed on the thyroid cartilage. The position of the holes should be at the middle 1/3 and the middle of the thyroid cartilage wing 1 to 2 mm below the vocal cord plane, respectively. A female patient can puncture the medial side of the thyroid cartilage wing with a blunt curved needle. Male patients with calcification of thyroid cartilage often need to drill a hole in the thyroid cartilage with a fine electric drill. After drilling, a core curved needle is inserted from the outer side of the thyroid cartilage wing to the inner side. After the needle core is pulled out, it will be bound to the seam on the muscle process. The thread is drawn through the pinhole to the outside of the thyroid cartilage wing. 7. Adjust the vocal cord adduction position and ligature the suture The thyroid cartilage was reset. After anesthesia of the nasal and pharyngeal mucosa with 1% tetracaine, the position of the vocal cords was observed by nasal insertion into a fiber laryngoscope. The position of the vocal cords is usually adjusted from the following four aspects: 1 pulling the sutures that are sewn to the muscles; 2 pressing the thyroidal cartilage in the midline; 3 ringing the cartilage; 4 pressing the thyroid to the dorsal side to relax the anterior and posterior vocal cords . The shoulder pillow should be removed during these operations to keep the patient in a position where it is easy to sound. The vocalization is usually improved when the suture is pulled upward (ventral side), and the patient is most satisfied with the vocalization when the suture is pulled to the proper tension. And when the glottis is observed under the fiber laryngoscope, the suture can be ligated without cracks, and the suture should not be too tight, so as to prevent the sacral cartilage from being pulled forward, making the voice worse. 8. Suture incision The incision was sutured layer by layer, drainage was placed, and light pressure bandaging was performed.