Vocal Fold Paralysis.ppt

Temporizing (Reversible) treatment Tracheostomy. Endo-extralaryngeal suture lateralization. Laryngeal botox injetion. Endo-extralaryngeal suture lateralization Lichtenberger Toohill. Nonabsorbable suture (endoscopically). Above below the posterior vocal fold (vocal process). Neck skin, secured over a button externally. Suture tension can be adjusted. Laryngeal botox injetion Airway obstruction is not imminent (exertional). TA-LCA muscular complex. Minor airway improvement (2 – 4 months). Blocking of synkinetic TA activity (inspiration). Breathy dysphonia, aspiration of liquids. Long-term surgical solution Tracheostomy. Transverse cordotomy. Endoscopic laser arytenoidectomy. Laryngeal pacing. Transverse cordotomy Kashima, 1991. Vocal quality ? worsen ? breathy, rough ?good conversational voice. Microlaryngoscopy ? CO2 laser ? transverse cordotomy anterior to vocal process. Transverse cordotomy Extend far laterally (division of the false vocal cord) ? detach as much of the TA muscle from arytenoid cartilage. TA muscle retracts anteriorly, heals over several weeks. Repeat ipsilaterally or contralaterally. Endoscopic laser arytenoidectomy Ossoff et al., 1984. Endoscopic total laser arytenoidectomy: CO2 laser (better hemostasis). Entire arytenoid cartilage is ablated. Small wedge is removed from posterior VF. A small cut just lateral to the wedge ? facilitate lateralization of VF during healing. Long-term success rate 86%. Vocal quality: subjectively good. Endoscopic laser arytenoidectomy Endoscopic laser partial arytenoidectomy: Preserves a portion of arytenoid. Reduces the risk of aspiration. Crumley: medial arytenoidectomy, preserves lateral aspect of arytenoid. Remacle: preserves posterior body of arytenoid. Less voice dysfunction (less disruption of membranous vocal fold). Laryngeal pacing The most promising treatment. Programmable pulse generator. Implant beneath the skin. PCA muscle (inspiration). Vocal Fold Paralysis Iatrogenic surgical causes Thyroidectomy. A