gms | German Medical Science

Introduction: The evaluation of glottic airway enlarging procedures nowadays is based on subjective questionnaires and functional respiratory tests. These interventions, even the latter one, are subjective because the patients overall healthy conditions have a great influence on the measurement. The objective way to compare different surgical techniques is the direct evaluation of the glottic area: The examination of cadaver larynges and the modern 3D imaging reconstruction provide the possibility of objective assessment.

Methods: In a cadaver morphometric study (100 larynges) three different suture vocal fold lateralizing methods (‘simple suture’ laterofixation, endoscopic abduction arytenoid lateropexy /EAAL/, Schobel’s external arytenoidopexy) and resection techniques (transverse chordotomy, arytenoidectomy) were analyzed by digital image analyzer program. Then Slicer 3D software was used to evaluate the glottic changes after EAAL; the pre- and postoperative CT scans in 10 patients (8 women, 2 men) were measured.

Results: All procedures provided significant improvement of the glottic gap, EAAL was found to be the most effective method. According to the 3D study the glottic area improved significantly (+64%) after EAAL.

Conclusion: The results support our clinical observations that the ideal place of fixating sutures is the one which provides physiological abduction position of the arytenoid cartilages. Considering these good results the surgical indications of minimally invasive endoscopic abduction arytenoid lateropexy may be extended.

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