Vocal Cord Paralysis - Alexorl

1 4/14/20091 Vocal cord ParalysisProf. Mohamed HeshamENT-Head & Neck Surgery DepartmentAlexandria Faculty of MedicineAlexandria, EgyptCricothyroid muscle Tensor Adductor !4/14/20092 Posterior cricoarytenoid The only abductor muscleCortexMedullaSLNRLNN erve supply of the larynx4/14/200934/14/20094 Vocal cord positions Six position are described by Negus,1947g, Median Paramedian Cadaveric Full abductionMedian4/14/20095 Acquired cord Paralysis It is a sign of a disease and not a diagnosis It may be due to a lesion at any point from the cerebral cortex to the neuromusular junction Left RLN is more affected than the right due to its longer courseCortexMedullaSLNC entralRLNC entral Cortical Bulbar4/14/20096 VagusSLNSLNRLNP eripheral injury Total vagus SLN RLNRLNA cquired cord Paralysis Malignant disease Surgical trauma Surgical trauma Idiopathic Nonsurgical trauma Inflamatory Neurologic

2 MiscellaneousMiscellaneous4/14/20097 Acquired cord Paralysis Malignant disease Surgical trauma Surgical trauma Idiopathic Nonsurgical trauma Inflamatory Neurologic Miscellaneous Thyroid surgery Partial laryngeal surgery Tracheal resection Neck dissection Cardiac SurgeryMiscellaneousgyAcquired cord Paralysis Malignant disease Surgical trauma Surgical trauma Idiopathic Nonsurgical trauma Inflamatory Neurologic Miscellaneous No cause is ever found for Paralysis Follow up for at least 18 months Viral !Miscellaneous4/14/20098 Acquired cord Paralysis Malignant disease Surgical trauma Surgical trauma Idiopathic Nonsurgical trauma Inflamatory Neurologic MiscellaneousMiscellaneousAcquired cord Paralysis Malignant disease Surgical trauma Surgical trauma Idiopathic Nonsurgical trauma Inflamatory Neurologic Miscellaneous Viral BacterialMiscellaneous4/14/20099 Acquired cord Paralysis Malignant disease Surgical trauma Surgical trauma Idiopathic Nonsurgical trauma Inflamatory Neurologic Miscellaneous Cerebrovascular disease Parkinsonism Neuropathies.

3 Alcohol,DMMiscellaneousAcquired cord Paralysis Malignant disease Surgical traumaChest causes Surgical trauma Idiopathic Nonsurgical trauma Inflamatory Neurologic MiscellaneousChest causesRtApical TBLeftCorpulmonaleAortic aneurysmOpen heart surgeryMiscellaneousMediastinal massesHypertrophied heart4/14/200910 AssessmentSymptoms and SingsSLN Paralysis Voice Breathing AspirationCord positionPhonationSlight hoarsenessRespirationNo stridorAspirationSlightAssessmentSymptom s and SingsUnilateral RLN Paralysis Voice Breathing AspirationCord positionParamedianPhonationMild

4 HoarsenessUnilateral RLN ParalysisPhonationMild hoarsenessRespirationNo stridorAspirationMild4/14/200911 AssessmentSymptoms and SingsBilateral RLN Paralysis Voice Breathing AspirationBilateral RLN ParalysisCord positionParamedianPhonationMild hoarsenessPhonationMild hoarsenessRespirationSevere stridorAspirationMildAssessmentSymptoms and SingsUnilateral Vagal Paralysis Voice Breathing AspirationUnilateral Vagal ParalysisCord positionIntermediatePhonationBreathy voiceRespirationNo stridorAspirationSevere4/14/200912 AssessmentInvestigationsRadiologyCh t X R Chest X Ray Barium swallow CT ScanAssessmentInvestigationsLaboratoryCB C CBC FBS TB4/14/200913 AssessmentInvestigationsPanendoscopyDit L Direct Laryngoscopy Bronchscoy Esophagoscopy NasopharyngoscopyTreatmentUnilateral ParalysisGeneral rulesI WhI.

5 When Unless the nerve is mechanically interupted recovry is the rule rather than the exception. Most recoveries take up from 6-12 months. In unrecoverable cases; the contralateral vc compensates by moving across the midline to achieve a satisfactory glottic , Expectant policy is advised for 6-12 months + speech therapy before definitive ParalysisGeneral rulesI WhI. WhenIndications for early surgical intervention Professional voice users If one could not expect complete or adequate recovery so the distress of weak voice and cough should be treated earlyshould be treated ParalysisGeneral rulesI Wh t t dI.

6 What to doDisplace the paralysed Vocal cord from the paramedian position to or near the midlineMedialization procedures Intracordal InjectionSi l di li ti Surgical medialization Vocal fold reinnervation4/14/200915 TreatmentUnilateral ParalysisTreatmentUnilateral ParalysisSurgical Medialization Prcedures MLI. Idea Isshiki 1974 (Thyroplasty I)An implant is placed between the thyroid cartilage and the vocalis muscle to medialize the membranous Vocal Medialization Prcedures MLLaryngeal Framework Surgeries4/14/200916 TreatmentBilateral ParalysisParamedian positionStridorBil.

7 RLN injuryLateralizationWidening proceduresReinnervationTreatmentBilatera l ParalysisArytenoidopexyypyEndoscopic4/14 /200917 TreatmentBilateral ParalysisArytenoidopexyExternalTreatment Bilateral ParalysisArytenoidectomyArytenoidectomyE xternal Aproach4/14/200918 TreatmentBilateral ParalysisEndoscopic Posterior Cordectomy ArytenoidectomyPost partial cordectomy4/14/200919 ReinnervationReinnervation4/14/200920 ReinnervationTreatmentComplete paralysisInractable aspiration Nasogastric tube Cuffed tracheostomyNasogastric tube, Cuffed tracheostomy Vocal cord augmentation, Cricothyroid myotomy Total Laryngectomy Surgical Closure of the larynx Epiglottic flap operation Diversion procedure Glottic closureEiltt Epiglottopexy4/14/200921