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ARD - Arytenoid Repositioning Device

last modified on: Sun, 08/13/2023 - 14:46

see also: Arytenoid Repositioning Device Video (2011 Experiment) 

see also: Transillumination technique (password protected): Transilluminating Obturator

click on video below

 

Standard approaches to arytenoid adduction and abduction require:

  • Neck incision
  • Transection of muscles
  • Removal of cartilage
  • Mobilization of the pyriform sinus
  • Dissection close to the carotid artery to place a suture in the muscular process of the arytenoid
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Placement of ARD (for abduction or adduction) requires:

  • Small anterior neck incision
  • No transection of muscles
  • No removal of cartilage
  • No mobilization of the pyriform sinus
  • No dissection close to the carotid artery to place the device employing an 18-gauge trocar through the cricothyroid membrane into the paraglottic space to engage the muscular process of the arytenoid​

Additional Benefits of the ARD:

  • 'Minimal Access Surgery'
  • Reversible
  • Permits positioning of arytenoid with greater precision than a suture

Adduction:

  • Unilateral laryngeal paralysis
  • Arytenoid subluxation/dislocation repositioning

Abduction:

  • Bilateral laryngeal paralysis
  • Acute placement (at time of thyroidectomy) chronic
  • Posterior glottic scarring - ancillary measure to grafting

(kk 4-2-09)

References

Hoffman HT, Heaford AC, Dailey SH, Bock JM, Van Daele DJ, Ahlrichs-Hanson JS, Quebbemann GJ, Johnson MN, Boltz JE, Tiedt SL. Arytenoid repositioning device. Ann Otol Rhinol Laryngol. 2014 Mar;123(3):195-205. doi: 10.1177/0003489414522968. PMID: 24633946.

Franco RA Jr. Addressing the Arytenoid in Paralytic Dysphonia Using the Adduction Arytenopexy. Adv Otorhinolaryngol. 2020;85:120-124. doi: 10.1159/000456690. Epub 2020 Nov 9. PMID: 33166973.

Prasad VMN, Remacle M. Medialization Thyroplasty and Arytenoid Adduction for Management of Neurological Vocal Fold Immobility. Adv Otorhinolaryngol. 2020;85:85-97. doi: 10.1159/000456686. Epub 2020 Nov 9. PMID: 33166967.

Yumoto E, Sanuki T, Kumai Y, Kodama N. Modified Isshiki's arytenoid adduction without separating cricothyroid and cricoarytenoid joints. Acta Otorhinolaryngol Ital. 2020 Apr;40(2):99-105. doi: 10.14639/0392-100X-N0183. PMID: 32469003; PMCID: PMC7256903.

Transoral arytenoid adduction with minimal cervical incision - PubMed (uiowa.edu)

Woodson G. Arytenoid abduction for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg. 2011 Dec;19(6):428-33. doi: 10.1097/MOO.0b013e32834cd564. PMID: 22001662.