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What Is Arytenoid Adduction?

Arytenoid adduction is laryngeal framework surgery that rotates and repositions a paralyzed arytenoid cartilage to improve vocal-fold closure. The procedure is most commonly used for unilateral vocal fold paralysis with a large posterior glottic gap or a vertical-level mismatch between the two vocal folds. A suture is placed to reproduce the pull that normally rotates the arytenoid inward during phonation. Arytenoid adduction is frequently combined with medialization thyroplasty when additional support of the vocal fold is needed.

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What Is Arytenoid Adduction?

Arytenoid adduction is laryngeal framework surgery that rotates and repositions a paralyzed arytenoid cartilage to improve vocal-fold closure. The procedure is most commonly used for unilateral vocal fold paralysis with a large posterior glottic gap or a vertical-level mismatch between the two vocal folds. A suture is placed to reproduce the pull that normally rotates the arytenoid inward during phonation. Arytenoid adduction is frequently combined with medialization thyroplasty when additional support of the vocal fold is needed.

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Why Is Arytenoid Adduction Performed?

The procedure is used when unilateral vocal fold paralysis causes breathy dysphonia, weak cough, aspiration symptoms, or poor glottic closure that is not adequately corrected by simpler medialization alone. It is particularly useful when the paralyzed arytenoid sits laterally or at a different vertical level from the functioning side. Laryngoscopy, voice assessment, swallowing symptoms, and the expected chance of nerve recovery help determine whether surgery is appropriate. Temporary injection procedures can be used first when spontaneous nerve recovery is still possible.

How Is Arytenoid Adduction Performed?

The surgeon reaches the laryngeal framework through a neck incision and exposes the muscular process or posterior aspect of the arytenoid. A suture is placed so traction rotates the arytenoid toward the midline and helps bring the vocal process into a better phonatory position. The suture is secured to the thyroid cartilage or another stable point after the position has been adjusted. Medialization thyroplasty can be performed during the same operation to correct residual glottic insufficiency.

What Is Recovery Like After Arytenoid Adduction?

Patients are monitored after surgery for airway swelling, bleeding, voice quality, pain, and swallowing difficulty. Voice rest or reduced voice use is commonly prescribed during early healing. Voice therapy can help the patient adapt to the new vocal-fold position and reduce compensatory strain. Voice and swallowing can continue to improve as swelling resolves and the larynx adapts over the following weeks to months.

What Are the Risks and Complications?

Possible complications include bleeding, infection, neck hematoma, airway swelling, swallowing difficulty, and an unsatisfactory voice result. Excessive adduction can over-medialize the vocal fold, while inadequate rotation can leave a persistent posterior gap. Injury to laryngeal cartilage, mucosa, nearby nerves, or the cricoarytenoid joint can affect voice or swallowing. Revision surgery can be needed if the suture loosens, the arytenoid position is inadequate, or symptoms remain significant.

Frequently Asked Questions About Arytenoid Adduction

Is arytenoid adduction the same as medialization thyroplasty?

No. Arytenoid adduction rotates the arytenoid cartilage, while medialization thyroplasty uses an implant to push the vocal fold toward the midline.

Why are arytenoid adduction and thyroplasty sometimes combined?

The two procedures address different parts of glottic insufficiency. Combining them can improve closure when both a posterior gap and loss of vocal-fold bulk or position are present.

Who is most likely to need arytenoid adduction?

It is commonly considered for unilateral vocal fold paralysis with a large posterior gap, arytenoid malposition, or a meaningful vertical-level difference between the folds.

Can arytenoid adduction improve swallowing?

It can improve airway protection in selected patients by improving glottic closure, although swallowing outcomes depend on the cause and severity of the underlying nerve dysfunction.

References

Unilateral Vocal Fold Paralysis. StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK519060/. Date Accessed August 13, 2026.

Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis. PubMed Central (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC4036824/. Date Accessed August 13, 2026.

Medialization Thyroplasty and Arytenoid Adduction for Management of Neurological Vocal Fold Immobility. PubMed. https://pubmed.ncbi.nlm.nih.gov/33166967/. Date Accessed August 13, 2026.

Outcomes of medialization laryngoplasty with and without arytenoid adduction. PubMed. https://pubmed.ncbi.nlm.nih.gov/28699172/. Date Accessed August 13, 2026.

Arytenoid adduction as an adjunct to type I thyroplasty for unilateral vocal cord paralysis. PubMed. https://pubmed.ncbi.nlm.nih.gov/9890351/. Date Accessed August 13, 2026.