Cricothyroid Subluxation
Cricothyroid subluxation is a procedure designed to improve voice in cases of differential tension on the vocal folds. The most common scenario is that of a paralyzed vocal fold with less tension than the normal side. Findings in these cases include decreased dynamic range, a poor noise:harmonic ratio, and differential resonant frequency between vocal folds due to flaccidity of paralyzed vocal fold. The differential tension will commonly produce the phenomenon of “diplophonia” (two voices), where each vocal fold will vibrate at a different frequency. This harsh and disordered voice quality is most easily elicited by having the patient speak loudly.
Indications/Contraindications
Reduced vocal fold tension on the paralyzed side is the most common indication.
A contraindication would be to perform the operation prior to the 6–9 month waiting period in cases of anticipated reinnervation of the paralyzed vocal fold. This concept is true for all laryngoplastic procedures (e.g., thyroplasty).
A larynx that has sustained trauma that meaningfully distorts the laryngeal superstructure represents a relative contraindication and should be approached with caution.
Prior laryngeal radiation is not a contraindication.
In the Clinical Setting
Key Points
Cricothyroid (CT) subluxation recreates the function of the ipsilateral cricothyroid muscle by increasing the distance between the arytenoid cartilage and the anterior commissure.
It can be used in conjunction with any arytenoid procedure; however, it should not be performed on a mobile vocal fold.
Pitfalls
Using a suture that is absorbable, or thinner than 2–0, may result in a loss of the desired effect.
Entering the airway lumen with the subluxation suture can lead to granulation tissue formation—it is important that the suture remain submucosal.
Over-tightening the suture will result in an abnormally high-pitched voice.
From a Technical Perspective
Key Points
Familiarity with the cricothyroid joint anatomy is crucial to performing an effective procedure.
As noted above, submucosal suture placement is crucial to prevent granulation within the airway.
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