Cases reported "Vocal Cord Paralysis"

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1/80. General anaesthesia for thyroplasty.

    A new anaesthetic technique is described for thyroplasty. Thyroplasty was performed to restore the voice in unilateral vocal cord paralysis. After skin incision and dissection down to the larynx, a window was cut in the thyroid ala and a silastic wedge used to displace the vocal cord medially. The required size of this wedge was determined by pre-operative computerized tomography scanning of the larynx. At this point the patient had to be awake and cooperative to allow repeated phonation to facilitate correct displacement of the vocal cord.
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keywords = voice
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2/80. Computerized tomography of the glottis after intracordal autologous fat injection.

    According to the committee on speech, voice, and swallowing disorders of the American Academy of otolaryngology-head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autologous fat in one patient in whom this material was used for injection laryngoplasty.
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3/80. technology in the assessment of voice disorder.

    The purpose of this article is to describe salient technologies available for assessing patients with disorders of voice. Measurements of jitter, shimmer, harmonic-to-noise ratio, fundamental frequency of the speaking voice, basal frequency, ceiling frequency, computation of pitch range, speaking intensity, intensity increase potential, vital capacity, laryngeal airflow during phonation, and laryngeal videoendoscopy-stroboscopy are covered. Some of the common instruments available to measure these voice components are described. Clinical case examples are provided to illustrate the importance of technology in the assessment of patients with voice disorder.
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keywords = voice
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4/80. Botulinum toxin injection in the treatment of vocal fold paralysis associated with multiple sclerosis: a case report.

    Botulinum toxin has been demonstrated clinically to be an effective treatment for a variety of laryngeal problems, most notably spasmodic dysphonia. As in other movement disorders, the theory behind the injection of this substance in the larynx has been a weakening of the vocal fold musculature to relieve uncoordinated and spasmodic movement of the vocal folds, presumably rebalancing the forces within the intralaryngeal musculature. Recently, this concept was applied to help reposition the arytenoid cartilage in acute and longstanding anteromedial cricoarytenoid dislocations. This same concept may apply to the paralyzed vocal fold. In support of this idea, a number of investigators have shown that immobile, clinically paralyzed vocal folds may still have partial voluntary motor unit activity. This voluntary activation may not produce clinically evident movement but may be sufficient to produce tone within the fold. If the voluntary motor units in the abductor musculature of the paralyzed fold are weakened with botulinum toxin, the continued pull of the functioning adductor musculature may be sufficient to medialize the paralyzed fold. This idea has been supported by animal experiments, which have shown that botulinum toxin may affect the ability of the fold to rebalance itself. With this evidence in mind, a patient with fold immobility secondary to multiple sclerosis was treated in an attempt at laryngeal rebalancing, using botulinum toxin to medialize the fold. However, instead of simply having the fold return fixed to the midline, the patient regained normal laryngeal mobility and voice. While it is unclear whether the botulinum toxin alone was responsible, the coincidence of this occurrence certainly requires reporting. This paper is a report of the first successful treatment of vocal fold paralysis using botulinum toxin to treat vocal fold fixation in a patient with multiple sclerosis.
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5/80. Left recurrent laryngeal nerve palsy associated with silicosis.

    Left recurrent laryngeal nerve palsy usually results from invasion or compression of the nerve caused by diseases localized within the aortopulmonary window. This study reports the case of a 76-yr-old male with vocal cord paralysis due to lymph node involvement by silicosis. This rare entity was identified by video-mediastinoscopy, which revealed a granulomatous and fibrosed recurrent lymph node encasing the nerve. The nerve was dissected and released from scar tissues. Progressive clinical improvement was observed followed by total and durable recovery of the voice after 15 weeks follow-up.
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keywords = voice
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6/80. Pediatric vocal fold medialization with silastic implant: intraoperative airway management.

    Vocal fold immobility accounts for 10% of all congenital laryngeal abnormalities, second only to laryngomalacia. Acquired unilateral vocal fold immobility (UVFI) is generally due to surgical trauma. The problems associated with this condition include a breathy dysphonia, weak cough, and aspiration. Treatment involves observation, voice and swallowing therapy, and various surgical options. Medialization laryngoplasty with silastic implant (ML-s) is a very successful procedure with consistent results in the adult population. It is usually done under local anesthesia with sedation to allow the voice to be monitored during the procedure. The surgeon can then fashion a custom implant or use a specific prefabricated implant. Additionally, use of the flexible fiberoptic nasopharyngolaryngoscope (FFNPL) allows the surgeon to see the endolarynx during the procedure, thus avoiding overmedialization and airway obstruction. Children, however, do not tolerate such invasive procedures under local anesthesia and sedation, have much smaller airways and, therefore, present several problems when addressing this problem surgically. Management of the pediatric airway during ML-s can be achieved using a laryngeal mask airway (LMA) and the FFNPL. While this does not allow the voice to be assessed intraoperatively, appropriate medialization of the vocal fold can be judged via the FFNPL, and airway obstruction avoided. ML-s using the LMA and FFNPL was performed in two children aged 8 and 4 years old. Both had excellent voice results and no complications. The details of these cases are reported. The literature on treatment of UVFI in children is reviewed, and practical and theoretical issues discussed.
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keywords = voice
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7/80. A benign parathyroid cyst presenting with hoarse voice.

    Parathyroid tumours and cysts are rare and, when presenting as neck masses, can be clinically misdiagnosed as thyroid lesions. Symptoms may be caused by compression of the surrounding structures or hormonal overactivity. This paper describes a patient with recurrent hoarseness owing to the pressure effects of a parathyroid cyst on the recurrent laryngeal nerve.
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keywords = voice
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8/80. Ortner's syndrome in association with mitral valve prolapse.

    The case of an 83-year-old woman with a history of hypertension, valvular heart disease, atrial fibrillation, and cardiomegaly is presented. The patient also had progressive hoarseness of her voice and intermittent dysphagia. Ear, nose, and throat examination revealed left vocal cord paralysis. echocardiography revealed severely dilated left (LA) and right atria (RA), moderate mitral regurgitation, severe tricuspid regurgitation, and prolapse of both these valves. A review of literature of Ortner's or cardiovocal syndrome is presented. Ortner's syndrome due to mitral valve prolapse has not been reported previously.
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keywords = voice
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9/80. Permanent iatrogenic vocal cord paralysis after I-131 therapy: a case report and literature review.

    A patient who underwent I-131 therapy for a solitary toxic thyroid nodule subsequently experienced vocal cord paralysis, a rare complication. The patient was examined because of hoarseness 1 week after treatment. Indirect laryngoscopy at the time confirmed right vocal cord paralysis. When the examination was repeated in 6 months, no improvement was noted; vocal cord paralysis was then declared permanent. Surprisingly, 11 months after the onset of symptoms, the patient observed improvement in her voice. At 14 months, she experienced complete vocal recovery. However, a computed tomography performed after this showed that her right vocal cord paralysis was unresolved. The apparent complete recovery of her voice is believed to be a result of adaptive compensatory mechanisms. patients who recover from hoarseness after injury to the recurrent laryngeal nerve should have cord function documented by indirect laryngoscopy or other means before the physician performs a procedure that could harm the contralateral nerve, because damage to this nerve could result in devastating consequences.
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keywords = voice
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10/80. Combined use of endoscopic CO2 laser excision of a marginal laryngeal tumor, radical neck dissection, and perioperative laterofixation of the opposite vocal cord.

    We report the use of endoscopic laser excision of a marginal laryngeal tumor, radical neck dissection, and laterofixation of a paralyzed vocal cord in a 66-year-old man who had an early-stage right supraglottic endolaryngeal tumor and ipsilateral neck metastasis. He had a left vocal cord paralysis after a left pneumonectomy that was performed 5 years previously. The primary laryngeal tumor was excised by endoscopic CO2 laser resection, and a simultaneous radical neck dissection was carried out. Postoperatively, severe inspiratory dyspnea developed because of the surgical intervention on the right side causing moderate laryngeal edema and limited movement of the right vocal cord in addition to the paralyzed left side. An endolaryngeal laterofixation of the paralyzed left vocal cord was performed to provide the patient with an adequate airway instead of tracheostomy. This patient had a 2 years' follow-up without recurrence of tumor. In the meantime movement of the right vocal cord has returned, so that the patient's voice was socially acceptable and he has a functioning larynx.
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ranking = 1
keywords = voice
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