Objective- To compare the mechanical properties of laryngeal tie-forward (LTF) surrogate constructs prepared with steel fixtures and No. 5 braided polyester or braided polyethylene by use of a standard or a modified suture placement technique. Sample- 32 LTF surrogate constructs. Procedures- Surrogate constructs were prepared with steel fixtures and sutures (polyester or polyethylene) by use of a standard or modified suture placement technique. Constructs underwent single-load-to-failure testing. Maximal load at failure, elongation at failure, stiffness, and suture breakage sites were compared among constructs prepared with polyester sutures by means of the standard (n = 10) or modified (10) technique and those prepared with polyethylene sutures with the standard (6) or modified (6) technique. Results- Polyethylene suture constructs had higher stiffness, higher load at failure, and lower elongation at failure than did polyester suture constructs. Constructs prepared with the modified technique had higher load at failure than did those prepared with the standard technique for both suture materials. All sutures broke at the knot in constructs prepared with the standard technique. Sutures broke at a location away from the knot in 13 of 16 constructs prepared with the modified technique (3 such constructs with polyethylene sutures broke at the knot). Conclusions and Clinical Relevance- Results suggested LTF surrogate constructs prepared with polyethylene sutures or the modified technique were stronger than those prepared with polyester sutures or the standard technique.

Objective- To evaluate anatomic landmarks to define the ideal suture placement location to achieve appropriate and consistent arytenoid cartilage abduction via unilateral cricoarytenoid lateralization (UCL) in dogs. Sample- 6 cadaveric canine larynges. Procedures- Laryngeal airway resistance (LAR) was determined for each specimen before (baseline) and after suture placements with the epiglottis open and closed. To achieve UCL, suture was placed through the cricoid cartilage just caudal to the cricoarytenoid articulation (suture placement position [SPP] 1), one-fourth of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 2), and three-fourths of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 3). The LAR was again calculated after tensioning of each suture separately. Results- With a closed epiglottis, median LAR was 30.0, 20.4, 11.4, and 3.3 cm H2O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPP 1, LAR with the epiglottis closed was not significantly different from that at baseline. With an open epiglottis, median LAR was 2.0, 0.4, 0.2, and 0.0 cm H(2)O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPPs 1, 2, or 3, LAR with an open epiglottis was significantly lower than that at baseline. Conclusions and Clinical Relevance- Results indicated that placement of suture through the cricoid cartilage at the caudal border of the cricoarytenoid articulation was appropriate to sufficiently reduce LAR without increasing the risk of aspiration pneumonia through overabduction of the arytenoid cartilage.