Adduction arytenopexy simulates the combined adductory actions of the thyroarytenoid, lateral cricoarytenoid, interarytenoid and the posterior cricoarytenoid musculature, which function synchronously in an agonist-antagonist fashion. In this procedure, the cricoarytenoid joint is opened to utilize the geographic anatomy of the cricoid facet to precisely position the arytenoid on the medial aspect of the cricoid facet, simulating normal adduction of the arytenoid.

This is in contrast to arytenoid adduction, which simulates the sole action of the lateral cricoarytenoid muscle.

Adduction arytenopexy is especially valuable when there is a substantial height differential of the vocal folds during adduction.

An adduction arytenopexy is rarely done without an accompanying implant in the paraglottic region.

The adduction arytenopexy is typically done first to close the posterior glottis and consequently a smaller implant is usually necessary.

Cricothyroid subluxation is the only laryngeal framework procedure specifically designed to better restore symmetry of the differential elasticity that results from denervation.

Consequently, adduction arytenopexy combined with cricothyroid subluxation facilitates maximum phonatory range tasks of frequency (e.g., 2 octaves) range and greater intensity (loudness).

Adequate local anesthesia (including the use of Marcaine along the inferior constrictor muscle attachment to the entire length of the posterior thyroid lamina) is important.

The inferior cornu of the thyroid lamina should be separated cleanly from the cricoid cartilage to facilitate the subsequent cricothyroid subluxation.

The greater cornu of the thyroid lamina may need to be separated from its connection to the hyoid bone to allow for anteromedial rotation of the posterior thyroid lamina to facilitate exposure.

Careful dissection along the inside aspect of the thyroid lamina in a caudal to cephalad direction avoids perforation of the piriform sinus.