Vocal Cord Paralysis

Vocal Cord Paralysis
Medialization Laryngoplasty
Shashidhar S. Reddy, MD, MPH
Faculty Sponsor: Anna Pou, MD
University of Texas Medical Branch

Overview
* Anatomy of the Larynx
* Function of the Larynx
* Causes of Vocal Cord Paralysis
* Evaluation of Vocal Cord Paralysis
* Anterior TVC Medialization
* Posterior TVC Medialization
* Overview of Treatment for Bilateral Vocal Cord Paralysis
* Conclusion (Key Points)

Anatomy of the Larynx - Cartilages
Anatomy of Larynx - Muscles
Anatomy of Larynx - Muscles
Anatomy of Larynx - Nerves
Anatomy of Larynx - Motion
Anatomy of the Larynx - Motion
* Adductors of the Vocal Folds
Anatomy of the Larynx - Motion
* Abductor of Larynx
Anatomy of Larynx - Histology
Function of Larynx

* Passage for Respiration
* Prevents Aspiration
* Allows Phonation
* Allows Stabilization of Thorax

Respiration
Phonation
Vocal Cord Paralysis
Etiology, Preoperative Evaluation, Treatment
Etiology
* Causes of Vocal Cord Paralysis in Adults
Neurologic
Intubation
Malignancy
Idiopathic
Surgery
Bilateral %
Unilateral %
Cause
Evaluation – Patient History
* Alcohol and Tobacco Usage
* Voice Abuse
* URI and Allergic Rhinitis
* Reflux
* Neurologic Disorders
* History of Trauma or Surgery
* Systemic Illness – Rheumatoid
* Duration – Affects Prognosis

Evaluation – Physical Examination
* Complete Head and Neck Examination
* Flexible Fiberoptic Laryngoscopy
* 90 degree Hopkins Rod-lens Telescope
* Adequacy of Airway, Gross Aspiration
* Assess Position of Cords
o Median, Paramedian, Lateral
o Posterior Glottic Gap on Phonation

Evaluation - Videostroboscopy
* Demonstrates subtle mucosal motion abnormalities
* Video-documentation (not available online)

Evaluation - Electromyography
* Assesses integrity of laryngeal nerves
* Differentiates denervation from mechanical obstruction of vocal cord movement
* Electrode in Thyroarytenoid and Cricothyroid

Evaluation - Electromyography
* Normal
* Fibrillation
* Polyphasic

Evaluation - Imaging
* Chest X-ray
* MRI of Brain
* CT Skull Base to Mediastinum
* Direct Laryngoscopy

Evaluation – Unilateral Paralysis
* Preoperative Evaluation
* Manual Compression Test

Evaluation – Unilateral Paralysis
* Assess extent of posterior glottic gap
* Consider consenting patient for both anterior and posterior medialization procedures

Management – Unilateral Paralysis
* Type of Anesthesia
Management – Unilateral Paralysis
Vocal Cord Injection
* Adds fullness to the vocal cord to help it better appose the other side
* Injection technique is similar regardless of material used
* Injection into thyroarytenoid/vocalis
* Injection can be done endoscopically or percutaneiously
* Poor correction of posterior glottic gap

Management – Unilateral Paralysis
Vocal Cord Injection
Vocal Cord Injection
Vocal Cord Injection - Materials
* Teflon
* Fat
* Collagen
* Hyaluronic Acid
* Calcium Hydroxyapatite gel (Radiance FN)
* Polydimethylsiloxane gel (Bioplastique)
* Teflon -
o Advantages
o Disadvantages

Management – Unilateral Paralysis
Vocal Cord Injection
* Fat
* Fat Injection
* Homologous Collagen
* Calcium Hydroxyapatite gel
Management – Unilateral Paralysis
Type I Thyroplasty
* Advantages
* Disadvantages

Type I Thyroplasty – Gore-Tex
* Gore-Tex
Management – Unilateral Paralysis
* Complications
* Controversies
Management – Unilateral Paralysis Results
Arytenoid Adduction
* Arytenoid Adduction
* Endoscopic Approaches
* Suture Placed to Cricoid Cartilage
* Zeitels Modification – Arytenopexy
Management – Unilateral Paralysis
Arytenoid Adduction – Modifications
* Complications
Reinnervation
Bilateral Abductor Paralysis
Expiration Inspiration
Conclusions – Key Points
* Anatomy
* Causes of Vocal Cord Paralysis
* Evaluation
* Management – Bilateral Paralysis

Vocal Cord Paralysis