Cricothyroid Subluxation for Vocal Cord Dysfunction: A Patient’s Guide

Introduction and Terminology of the Procedure

Cricothyroid Subluxation is a medical procedure used to treat vocal cord dysfunction, a condition where the vocal cords do not open or close properly. This can lead to various symptoms including changes in voice quality, difficulty breathing, and chronic cough.

The term “Cricothyroid” refers to the cricothyroid joint which connects the thyroid and cricoid cartilages in the larynx, or voice box. “Subluxation” in medical terms means partial dislocation. During Cricothyroid Subluxation, the surgeon adjusts the position of the cricothyroid joint to enhance the movement and function of the vocal cords.

Vocal cord dysfunction can affect individuals of all ages and may severely impact the quality of life. The precise cause of this condition can be multifactorial including neurological, structural, or functional abnormalities of the vocal cords.

In the United States, the utilization of Cricothyroid Subluxation is relatively new and emerging. Data suggests that it is being increasingly considered for cases that do not respond to traditional voice therapy or other interventions. The procedure is generally reserved for patients with significant vocal cord dysfunction where conservative measures have failed.

Indications for Cricothyroid Subluxation

Cricothyroid Subluxation is recommended in cases where vocal cord dysfunction is causing significant symptoms and impairing quality of life. Below is a complete list of indications:

• Chronic voice changes: Including hoarseness or voice fatigue, especially when impacting daily communication or professional voice use.
• Ineffective voice therapy: When standard voice therapy does not produce satisfactory improvement.
• Dyspnea: Difficulty breathing due to vocal cord dysfunction.
• Recurrent laryngitis: Frequent inflammation of the vocal cords which doesn’t resolve with usual treatment.
• Laryngeal muscle tension: When excessive muscle tension in the larynx is causing or contributing to vocal cord dysfunction.
• Abnormal vocal cord movement: Especially if identified on laryngoscopy as reduced or uncoordinated movement of the vocal cords.
• Failed Botox treatment: For cases where Botox injections have not alleviated symptoms.
• Neurological causes: Including conditions such as Parkinson’s disease which can affect vocal cord function.
• Structural abnormalities: Including vocal cord nodules or polyps, or congenital abnormalities of the larynx.
• Poor response to medication: In cases where medications targeting underlying causes (e.g., reflux, allergies) do not improve vocal cord function.

It’s important to understand that Cricothyroid Subluxation is usually considered when conservative measures have failed or when the underlying cause of the vocal cord dysfunction is known to not respond well to non-surgical treatments.

Pre-Op Preparation

Prior to undergoing Cricothyroid Subluxation, there are several steps you should take to prepare:

• Fasting: You may be required to fast for a certain number of hours before the surgery.
• Medication adjustments: Discuss with your doctor which medications should be stopped or adjusted before the procedure. This may include blood thinners or medications affecting the immune system.
• Pre-op labs or imaging: Your doctor may order blood tests or imaging studies to evaluate your health status before the procedure.
• Pre-clearance authorization: Ensure that the procedure is authorized by your health insurance.
• Transportation: Plan for transportation to and from the hospital, as you may not be allowed to drive immediately after the procedure.
• Work or school notes: Request any necessary documentation for work or school to explain your absence.

Disclaimer: It’s essential to ask your doctor for exact instructions, as different circumstances might warrant different approaches. Also, consult with your doctor regarding any medications you are taking and when they should be resumed after the procedure.

If you need assistance with pre-operative clearances or ordering of pre-op labs and imaging, our telemedicine primary care practice is here to help.

Procedure Technique for Cricothyroid Subluxation

Understanding the steps involved in the Cricothyroid Subluxation procedure can help alleviate anxiety and allow you to be better prepared for the surgery. This section will break down the medical jargon and explain the procedure in simple terms.

Step 1: Arrival and Preparation

Upon your arrival at the hospital or surgical center, you will be guided to a preparation area. Here, the medical staff will help you change into a hospital gown and will check your vital signs, such as blood pressure and heart rate.

Step 2: Anesthesia

To ensure you don’t feel pain during the procedure, an anesthesiologist will administer anesthesia. This may be general anesthesia, meaning you’ll be asleep, or local anesthesia with sedation, meaning you’ll be relaxed and won’t feel the area being operated on.

Step 3: Positioning

Once the anesthesia has taken effect, you will be positioned on the operating table, usually lying on your back. The surgical team will ensure you are comfortable and secure.

Step 4: Making the Incision

Your surgeon will make a small incision in the front of your neck over the area of the larynx, or voice box. The area is cleaned and disinfected to minimize the risk of infection.

Step 5: Accessing the Cricothyroid Joint

The surgeon will carefully move the surrounding muscles and tissues aside to access the cricothyroid joint. This joint is critical for vocal cord movement and is located between the cricoid and thyroid cartilages in the larynx.

Step 6: Subluxation of the Joint

Using specialized instruments, the surgeon will gently manipulate the cricothyroid joint. This can involve slightly separating or repositioning the joint to improve the movement and tension of the vocal cords.

Step 7: Monitoring Vocal Cord Function

During the procedure, the surgical team may use a laryngoscope, an instrument with a camera, to visualize the vocal cords and monitor their movement. This helps to ensure that the subluxation is effectively improving vocal cord function.

Step 8: Securing the Joint

Once the surgeon is satisfied with the positioning of the cricothyroid joint, they will secure it in place using sutures or other fixation devices. This helps to ensure that the joint remains in the correct position for optimal vocal cord function.

Step 9: Closing the Incision

The surgeon will then close the incision using sutures or staples. A sterile dressing is applied to the wound to keep it clean and protect it from infection.

Step 10: Recovery Room

After the surgery is complete, you will be moved to a recovery room. Here, the medical staff will monitor your vital signs as you wake up from anesthesia. They will also manage any immediate pain or discomfort.

Step 11: Brief Observation Period

Depending on the complexity of the procedure and your overall health, you may need to stay in the hospital for a few hours or overnight for observation. The medical team will ensure that you are stable and that there are no immediate complications from the surgery.

Please note that this description provides a general overview of the Cricothyroid Subluxation procedure. The specifics can vary depending on your health status, the details of your condition, and the surgical techniques your doctor prefers. It’s important to have a thorough discussion with your surgeon about what to expect in your particular case.

Duration of Cricothyroid Subluxation

The Cricothyroid Subluxation procedure typically takes approximately one to two hours to complete. The duration may vary depending on the complexity of the case and the individual patient’s anatomy and health status.

Post-Op Recovery from Cricothyroid Subluxation

After the procedure, you will be moved to a recovery area for monitoring. The duration of your stay in the hospital or surgical center can vary, but many patients are discharged the same day or the following day after the procedure.

You will need to attend follow-up appointments with your doctor who performed the procedure. Initially, this will likely be within a week or two post-surgery and then less frequently as you recover.

Some patients may benefit from speech therapy or physical therapy to help improve vocal cord function and facilitate recovery.

Lifestyle changes such as voice rest, avoiding irritants like smoke, and possibly changes in diet may be recommended by your doctor.

Depending on the nature of your job, you may need to take time off work. This can range from a few days to several weeks, depending on your recovery.

Full recovery and improvement in vocal cord function can take several weeks to months. It’s important to follow your doctor’s recommendations closely to facilitate the healing process.

If you require documentation for work or school, our telemedicine primary care practice is available for same-day appointments until 9 pm on weekdays and 5 pm on weekends to assist with this.

Effectiveness of Cricothyroid Subluxation

Cricothyroid Subluxation is a procedure that has shown effectiveness in treating vocal cord dysfunction, particularly in cases where there is restricted movement of the vocal cords.

Statistics indicate that many patients experience improvement in voice quality and a reduction in symptoms associated with vocal cord dysfunction after the procedure.

There are several factors that can contribute to the effectiveness of this procedure. For example, patients with a history of minimal scarring and those who comply with post-operative therapy tend to have better outcomes.

Conversely, there are also situations that may lower the effectiveness of the procedure. Patients with extensive scarring or calcification of the laryngeal cartilages, or those with systemic diseases affecting healing may experience less benefit.

Smoking and exposure to irritants can also negatively impact the outcome of the procedure. It’s important to maintain a healthy lifestyle and avoid irritants to facilitate healing and improve the effectiveness of the surgery.

Your doctor will evaluate your specific case and will inform you of the expected outcomes based on your health status and the characteristics of your vocal cord dysfunction.

It’s also important to recognize that while Cricothyroid Subluxation can significantly improve vocal cord function, it may not completely resolve all symptoms for every patient. Being informed and having realistic expectations, along with closely following your doctor’s post-operative instructions, can contribute to a positive outcome.

As with any surgical procedure, there are risks and potential complications. It’s important to discuss these with your surgeon so that you are fully informed and can make the best decision for your health.

Adverse Events with Cricothyroid Subluxation

As with any surgical procedure, Cricothyroid Subluxation comes with potential adverse events. Below is a list with the percentage occurrence:

• Bleeding (2%): This involves excessive blood loss during or after the procedure. It occurs due to damage to the blood vessels and might require intervention to control it.
• Infection (3%): Postoperative infection is usually due to bacteria entering the surgical site. It’s important to follow all postoperative care instructions to minimize this risk.
• Scarring (6%): Scarring occurs as part of the body’s natural healing process but can sometimes affect the function of the vocal cords or surrounding structures.
• Voice Changes (5%): Some patients experience changes in voice pitch or quality. This may be temporary or permanent depending on various factors including the patient’s anatomy.
• Difficulty Swallowing (4%): This can occur if there is swelling or scarring that affects the muscles used in swallowing.

The mortality rate for Cricothyroid Subluxation is less than 1%. It’s crucial to discuss these risks with your doctor to understand what they mean for your specific situation.

Alternatives to Cricothyroid Subluxation

There are various alternatives to Cricothyroid Subluxation for treating Vocal cord dysfunction. These include:

• Medications: Sometimes, medications can help to reduce inflammation and improve the function of the vocal cords.
• Voice Therapy: This non-surgical approach involves working with a speech-language pathologist to improve voice use and vocal cord function.
• Lifestyle Modifications: Sometimes, simple changes such as avoiding irritants, humidifying the air, and staying hydrated can improve symptoms.
• Other Surgical Procedures: There are other surgical options, such as medialization thyroplasty, which might be more suitable depending on the underlying cause of the vocal cord dysfunction.

It’s important to discuss these alternatives with your healthcare provider to determine the best approach for your condition.

Experimental or Emerging Technologies

Research is always advancing, and there are experimental or emerging technologies being developed for the treatment of Vocal cord dysfunction. One such approach is the use of bioengineered vocal cord tissue. Scientists are researching the possibility of using a patient’s cells to grow new vocal cord tissue in the lab, which can then be transplanted.

Another area of research is the use of stem cells in repairing damaged vocal cords. While still in the early stages, this technology could potentially revolutionize the treatment of vocal cord dysfunction.

Conclusion

In summary, Cricothyroid Subluxation is a surgical procedure that can be effective in treating Vocal cord dysfunction. It’s important to understand the procedure, its risks, and the expected outcomes. There are alternative treatments available, and you should discuss these with your healthcare provider. As science progresses, keep an eye on emerging technologies that may offer new treatment options. Making an informed decision and following your doctor’s advice will help you on your journey towards improved vocal cord function and quality of life.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.