Description and evaluation of a novel transoral endoscopic arytenopexy in canine cadavers.

Objective: To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic-glottic seal (LEGS). We hypothesize the TEA will be a feasible surgical technique and the TEA will provide a significant increase in RGA with minimal change to the LEGS.

Study Design: Canine cadaveric model.

Animals: Fifteen medium- to large-breed canine cadavers.

Methods: Endoscopic photos of the larynx were taken with the epiglottis open for baseline RGA measurement and closed for baseline measurement of exposed RGA and LEGS. A custom endoscopic gag port (EGP) facilitated the TEA, performed by suturing the lateral aspect of the left arytenoid soft tissues to adjacent pharyngeal wall across the piriform recess. Endoscopic photos were repeated to measure changes in RGA and LEGS. A computerized planimetric analysis program was used to calculate baseline RGA and LEGS. The RGA was reported in % change from baseline. The LEGS was reported as intact or altered. A nonparametric Wilcoxon signed-rank test was used to compare baseline to post-TEA RGA.

Results: The mean baseline RGA was 0.52 ± 0.28 cm and mean post-TEA RGA was 0.78 ± 0.37 cm (p-value < .0001). The LEGS remained intact post-TEA in all cadavers.

Conclusions: The TEA was technically feasible and resulted in an increase in RGA while maintaining the LEGS.

Clinical Significance: The TEA may provide a minimally invasive addition to the established techniques for reducing airway resistance while minimizing the impact on the LEGS.