The Posterior Thyroplasty Window: Anatomical Considerations

Objectives: Explain surgical technique of performing a posterior thyroplasty window. 1 Describe the internal laryngeal anatomy and structures available through the posterior window approach. Describe posterior window approach. Study Design: Review of lateral laryngeal anatomy and retrospective review of 125 cases involving a posterior thyroplasty window approach. Review mechanics of stress and stress concentration inherent with partial removal of rigid substance. Describe anatomical considerations and surgical complications. Methods: Charts were reviewed and tabulated for surgical complications, efficacy and safety of surgical approach, specific anatomical variations, and variety of surgery available through the posterior window. Results: Performance of 125 posterior thyroplasty windows revealed no evidence of entry into the piriform sinus. Three thyroid ala fractures ensued, two of the body and one of the inferior cornu. Operations available included arytenoid adduction, 1 arytenoid fixation, 2 lysis of joint adhesions, and access to the posterior cricoarytenoid muscle for botulinum toxin injections. Conclusions: The posterior thyroplasty window affords easy, direct access to the internal, posterolateral larynx while preserving the cricothyroid joint, the action of the cricothyroid muscle, and the internal division of the recurrent laryngeal nerve.