19 May 2009

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

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18 May 2009

Joints Presentations



The Elbow and Radioulnar Joints

Joints

Articulations

Upper Extremity Joints

Joints

Joints - Articulations

The Wrist and Hand Joints


Dem Bones

Arm, Elbow, Forearm

Upper Extremity Injuries

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Elbow, Wrist & Hand presentations



Elbow, Wrist & Hand Evaluation

The Shoulder Girdle
R.T. Floyd, EdD, ATC, CSCS

Muscular Analysis of Upper Extremity Exercises

The Shoulder Joint

Muscular Analysis of Trunk and Lower Extremity Exercises

Foundations of Structural Kinesiology

Source:Eastern Illinois University

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