Yagudin R. Clinical and anatomical rationale for plastic arytenocordotomy in treatment of bilateral vocal fold immobility.

SUMMARY Yagudin R.K. Clinical and anatomical rationale for plastic arytenocordotomy in treatment of bilateral vocal fold immobility. - The manuscript. The dissertation for obtaining an academic degree of the candidate of medical sciences in speciality 14.01.19 - otorhinolaryngology. - Kolomyichenko Otolaryngology Institute of the Ukrainian Academy of Medical Sciences, Kyiv, 2009. The thesis deals with the morphometric, experimental and clinical rationale for new surgical technique in treatment of bilateral vocal fold immobility - plastic arytenocordotomy (PAT). Proposed surgery differs from other methods of widening the laryngeal lumen by transposition of two triangular flaps of mucous membrane, which are formed from upper and lower surfaces of vocal folds. Morphometric analysis revealed that this surgery can be done on any patient irrespective of age and sex. Cadaver experiments proved that bilateral PAT widens the glottis by a median of 9.55 mm (8.3 - 10) in male and 8.5 mm (7.4 - 8.8) in female. During clinical study, all female patients with bilateral vocal fold immobility were evaluated with the peak inspiratory flow (PIF) before treatment. Two values of PIF were proposed for assessment of surgery success. The clinical efficacy of PAT was assessed in retrospective and "before-and-after" study analyses and it was found that PAT is useful. After treatment, 87% of patients were able to attain PIF ? 2.0 l/s, flow of 69.6% of patients exceeded 2.5 l/s. It was found that PIF significantly correlates with exercise tolerance improvement. The wound complication analysis revealed that accurate approximation of mucous lining of anterior commissure during laryngofissure closure significantly reduces incidence of postoperative granuloma formation from 50% to 7.1%. It was determined that duration of laryngeal packing after PAT should be shortened to 3 days, which makes decannulation possible in 4 - 7 days and tracheotomy suturing in 4 - 9 days after surgery. Key words: plastic arytenocordotomy, bilateral vocal fold immobility, peak inspiratory flow.