Feasibility of Laryngeal Joint Replacement: A Proof of Concept Study in Cadavers.

Abstract

Objective: Posterior laryngeal stenosis is a vexing problem despite efforts at early tracheostomy in those intubated on ventilatory support. Treatment in advanced cases relies on permanent tracheostomy or irreversible arytenoidectomy/cordectomy, which are compromises between voice, swallowing, and airway. While having intact laryngeal neuromuscular function, there is immobility of the vocal cord due to scarring and ankylosis of the cricoarytenoid joint. In this proof of concept study, we explore the feasibility of repairing cricoarytenoid joint function with joint replacement in the fresh cadaver model.

Study design: Fresh human cadaver dissection to expose the cricoarytenoid joint.

Setting: Academic Medical Center, Cadaver Dissection Lab.

Methods: Two laryngeal surgeons attempted to expose the cricoarytenoid joint posterolaterally from an external cervical approach in five fresh human cadavers.

Results: One surgeon familiar with the joint anatomy was able to reproducibly expose the joint by exposing and opening the joint capsule without disruption of the surrounding intrinsic laryngeal neuromuscular or cricoarytenoid joint ligamentous structures in five joints, and the other surgeon was able to as well after observing the first surgeon's approach in three consecutive approaches after an initial failed attempt. It was also demonstrated that a 4 mm titanium implant screw was able to be placed into the posterior cricoid joint facet, onto which a 3-D printed or milled joint surface can be mounted. Joint abduction and adduction forces were measured to determine endpoints for the joint scar release.

Conclusion: We demonstrate that it is feasible to expose the cricoarytenoid joint without neuromuscular or joint ligamentous injury from an external approach and insert an anchor for a hemiarthroplasty system.

Level of evidence: N/A.