Research Article| Volume 33, ISSUE 5, P611-619, September 2019

Quantitative Measurement of the Three-dimensional Structure of the Vocal Folds and Its Application in Identifying the Type of Cricoarytenoid Joint Dislocation



      The objective of this study was to quantitatively measure the three-dimensional (3D) structure of the vocal folds in normal subjects and in patients with different types of cricoarytenoid dislocation. We will analyze differences in parameters between the groups and also determine if any morphologic parameters possess utility in distinguishing the type and the degree of cricoarytenoid dislocation.

      Study Design

      This retrospective study was conducted using university hospital data.


      Subjects' larynges were scanned using dual-source computed tomography (CT). The normal subjects were divided into deep-inhalation and phonation groups, and patients with cricoarytenoid joint dislocation were divided into anterior-dislocation and posterior-dislocation groups. Membranous vocal fold length and width were measured directly on the thin-section CT images. Vocal fold and airway 3D models were constructed using Mimics software and used in combination to measure vocal fold thickness, subglottal convergence angle, and oblique angle of the vocal folds.


      The phonation group displayed a greater vocal fold width, greater oblique angle, thinner vocal folds, and a smaller subglottal convergence angle than those of the deep-inhalation group (P < 0.05). The anterior-dislocation group displayed a smaller oblique angle and subglottal convergence angle than the posterior-dislocation group (P < 0.05).


      The 3D structure of the vocal folds during deep inhalation and phonation can be accurately measured using dual-source CT and laryngeal 3D reconstruction. As the anterior-dislocation group yielded negative values for the oblique angle and the posterior-dislocation group yielded positive values, the oblique angle of the vocal folds may possess utility for distinguishing the type and for quantitatively determining the degree of cricoarytenoid dislocation.

      Key Words

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        • Patel R.
        • Dailey S.
        • Bless D.
        Comparison of high-speed digital imaging with stroboscopy for laryngeal imaging of glottal disorders.
        Ann Otol Rhinol Laryngol. 2008; 117: 413-424
        • Khoddami S.M.
        • Nakhostin A.N.
        • Izadi F.
        • et al.
        The assessment methods of laryngeal muscle activity in muscle tension dysphonia: a review.
        Sci World J. 2013; 2013: 77-87
        • Poburka B.J.
        A new stroboscopy rating form.
        J Voice. 1999; 13: 403-413
        • Krausert C.R.
        • Olszewski A.E.
        • Taylor L.N.
        • et al.
        Mucosal wave measurement and visualization techniques.
        J Voice. 2011; 25: 395-405
        • Berry D.A.
        • Montequin D.W.
        • Chan R.W.
        • et al.
        An investigation of cricoarytenoid joint mechanics using simulated muscle forces.
        J Voice. 2003; 17: 47-62
        • Deguchi S.
        • Kawahara Y.
        • Takahashi S.
        Cooperative regulation of vocal fold morphology and stress by the cricothyroid and thyroarytenoid muscles.
        J Voice. 2011; 25: e255-e263
        • Saigusa H.
        • Kokawa T.
        • Aino I.
        • et al.
        Arytenoid dislocation: a new diagnostic and treatment approach.
        J Nippon Med Sch Nippon Ika Daigaku zasshi. 2003; 70: 382
        • Rubin A.D.
        • Hawkshaw M.J.
        • Moyer C.A.
        • et al.
        Arytenoid cartilage dislocation: a 20-year experience.
        J Voice. 2006; 19: 687-701
        • Zhuang P.
        • Nemcek S.
        • Surender K.
        • et al.
        Differentiating arytenoid dislocation and recurrent laryngeal nerve paralysis by arytenoid movement in laryngoscopic video.
        Otolaryngol Head Neck Surg. 2013; 149: 451
        • Thayer S.R.
        • David B.I.
        • Spiegel J.R.
        Arytenoid dislocation: diagnosis and treatment.
        Laryngoscope. 1994; 104: 1353-1361
        • Xu X.
        • Wang J.
        • Devine E.E.
        • et al.
        The potential role of subglottal convergence angle and measurement.
        J Voice. 2017; 31 (116–e1)
        • Hollien H.
        Vocal fold dynamics for frequency change.
        J Voice. 2014; 28: 395-405
        • Komorn R.M.
        • Smith C.P.
        • Erwin J.R.
        Acute laryngeal injury with short-term endotracheal anesthesia.[J].
        Laryngoscope. 1973; 83: 683-690
        • Norris B.K.
        • Schweinfurth J.M.
        Arytenoid dislocation: an analysis of the contemporary literature.
        Laryngoscope. 2011; 121: 142-146
        • Wang Q.
        • Liang L.
        • Liu Y.
        • et al.
        Quantitative analysis of the visor-like vertical motion of the cricoarytenoid joint in the living subject.
        J Voice. 2016; 30: 354
        • Mau T.
        Three-dimensional morphometric analysis of cricoarytenoid subluxation.
        J Voice. 2012; 26: 133-136
        • Boresi A.P.
        • Chong K.P.
        • Lee J.D.
        Elasticity in Engineering Mechanics.
        3rd ed. Wiley, Hoboken2010: 65
        • Sataloff R.T.
        Voice Science.
        Plural Publishing, Inc., San Diego2005: 178-180