Superomedial partial arytenoidectomy for voice improvement by correction of posterior glottic insufficiency

PURPOSE: Arytenoid resection is a well-known intervention to improve glottic airway. Superomedial partial arytenoidectomy (SPA) can also be used for voice improvement by correcting posterior glottic insufficiency in patients with an obstructing anteromedially prolapsed arytenoid. Posterior glottic insufficiency can be difficult to address and traditionally involves challenging arytenoid repositioning procedures. This study aimed to compare postoperative functional voice outcomes in patients who underwent SPA to pre-operative voice status. Second, consequences of concomitant injection augmentation in patients who underwent SPA were studied. Additionally, presenting the surgical technique. METHODS: In this retrospective cohort study, pre-operative and postoperative clinical data of patients who underwent SPA between 2004 and 2018 were analyzed. Both short- and long-term voice outcomes were assessed using Voice Handicap Index (VHI) and maximum phonation time (MPT). Pre- to postoperative assessment changes (delta: δ) were applied to multivariate analyses. RESULTS: A total of 105 patients were included, of which 91 had hemilaryngeal immobility, 25 had undergone previous phonosurgical procedures and 45 received concomitant injection augmentation. Patients who underwent SPA had significant improvement of VHI and MPT. In 81% of our population, laryngeal framework surgery was avoided. Multivariate analyses showed significantly improved short-term voice outcomes in patients who received injection augmentation concomitantly to SPA. Finally, δMPT was a significant predicting factor regarding additional procedures in patients who underwent SPA. CONCLUSION: SPA is a safe and efficient procedure for voice improvement in patients with posterior glottic insufficiency due to an obstructing anteromedially prolapsed arytenoid. We recommend performing this procedure combined with injection augmentation.