Modifications to the Fenestration Approach for Arytenoid Adduction Under Local Anesthesia.

Summary Objective We modified the fenestration approach for arytenoid adduction to make it easier to perform the surgery. The aim of this study was to evaluate the usefulness of our modifications, which included (1) use of an Alexis wound retractor (Applied Medical) to secure the surgical field through a small incision, and (2) use of a 12-mm, 1/2 R, insert-molded taper needle with 3-0 nylon suture to prevent damage to the arytenoid cartilage. Study Design This is a retrospective non-randomized observational cross-sectional study. Methods We compared the operative time and skin incision length between the conventional fenestration approach and our modified procedure, and verified the improvement of patients' voice by our procedure. Results Seven patients underwent the conventional fenestration approach for arytenoid adduction with type I thyroplasty, whereas nine patients underwent our modified fenestration approach for arytenoid adduction with type I thyroplasty. The skin incision length with our modifications (median, 3.0 cm; interquartile range [IQR], 3.0–4.0) was significantly shorter than with the conventional procedure (median, 5.0 cm; IQR, 4.3–5.8) ( P  = 0.001). The operative time with our modifications (median, 95 minutes; IQR, 90–100) was significantly shorter than without our modifications (median, 115; IQR, 100–130) ( P  = 0.035). All patients who underwent our modified fenestration approach for arytenoid adduction had maximum phonation time greater than 11 seconds after surgery. Conclusions Our two distinctive modifications reduced the operative time and skin incision length for the fenestration approach, which improved the procedure by making it less invasive.