Glottic closure patterns: Type I thyroplasty versus type I thyroplasty with arytenoid adduction

Anya J. Li, Michael M. Johns, Cristina Jackson-Menaldi, Seth Dailey, Yolanda Heman-Ackah, Albert Merati, Adam D. Rubin

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Objectives/Hypothesis: The goal of laryngeal framework surgery in patients with unilateral vocal fold paralysis is to improve glottic closure by medializing the paralyzed vocal fold. Type I thyroplasty (Th) and arytenoid adduction (AA) are two of the most commonly performed procedures. Two of the main rationales for performing an AA are to improve closure of the posterior glottis and correct vertical height discrepancy. The purpose of this study was to evaluate if AA with Th yields better posterior glottic closure and vertical height equality than Th alone. Study Design: Retrospective. Methods: Using visual analog scales, three blinded reviewers evaluated glottic closure patterns in patients who underwent Th or Th with AA. Pre- and postoperative videostroboscopic examinations of 45 patients with unilateral vocal fold paralysis, who underwent laryngeal framework surgery, were evaluated. Results: No significant difference was identified in postoperative scores for midmembranous glottis closure (P = 0.282), closure just anterior to the vocal processes (P = 0.426), respiratory glottis closure (P = 0.158), or vertical height discrepancy (P = 0.113). Conclusions: Although larger glottic gaps and vertical height discrepancies may lead some surgeons to predict that an AA is warranted, the usefulness of AA may not always be related to these parameters. Ultimately, voice improvement and not geometry should guide the surgeon's decision making.

Original languageEnglish (US)
Pages (from-to)259-264
Number of pages6
JournalJournal of Voice
Issue number3
StatePublished - May 2011
Externally publishedYes


  • Arytenoid adduction
  • Dysphonia
  • Glottic closure
  • Glottic insufficiency
  • Gore-Tex
  • Laryngeal framework surgery
  • Thyroplasty
  • Videostroboscopy
  • Vocal fold paralysis
  • Vocal fold paresis

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing
  • LPN and LVN


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