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PubMed2003

Congenital bilateral adductor vocal cord paralysis.

Bilateral adductor vocal cord paralysis (BAdP), presenting with features of laryngeal incompetence, is a rare form of congenital bilateral vocal cord paralysis, and only 2 small series of BAdP have previously been published. Three cases are reported here. The BAdP occurred as an isolated abnormality in 1 child, and was associated with a recognizable syndrome (Robinow's syndrome and 22q deletion) in the other 2 children. Gastrostomy tube feeding was required in 2 children, who both remain gastrostomy tube-dependent at 26 months and 10 years 9 months of age. The child with Robinow's syndrome received parenteral nutrition until 2 months, but was then able to feed orally after partial improvement in vocal cord function. The global impairment in vocal cord constrictor function observed in these 3 children is consistent with the site of lesion's being at the level of the laryngeal constrictor motoneurons in BAdP.

Chromosomes, Human, Pair 22↗
PubMed2005

Traction of lateral cricoarytenoid muscle for unilateral vocal fold paralysis: comparison with Isshiki' s original technique of arytenoid adduction.

Between 1995 and 1997, we performed Isshiki's original method of arytenoid adduction alone or as an adjunct to type I thyroplasty for the treatment of unilateral vocal fold paralysis. From 1997 onward, we performed arytenoid adduction by traction of the lateral cricoarytenoid muscle (Iwamura's method), because it reduces discomfort to the patient and avoids rotation of the thyroid cartilage. Preliminary experiments and surgical procedures involving traction of the lateral cricoarytenoid muscle are described. Of 21 patients with a maximum phonation time of less than 9 seconds, 14 underwent type I thyroplasty as an adjunct to our method of arytenoid adduction and 7 underwent arytenoid adduction alone. Sixteen patients (76%) were able after surgery to extend their maximum phonation time beyond 10 seconds; this result compares favorably with the results of Isshiki's original adduction technique. We describe useful anatomic landmarks for approaching the lateral cricoarytenoid muscle in the hope that more voice surgeons will adopt this approach in the treatment of unilateral vocal fold paralysis.

Adolescent↗
PubMed2005

Congenital bilateral vocal cord paralysis and the role of glycine.

OBJECTIVES: We sought to modify normal laryngeal constrictor (LC) motoneuron activity to induce a pattern of aberrant LC muscle function that may serve as a model of congenital bilateral vocal cord paralysis. METHODS: Single unit extracellular recordings of functionally identified LC motoneurons were made in anesthetized Sprague-Dawley rats, and the response to both intravenous and iontophoretic application of the glycine antagonist strychnine was studied. RESULTS: The postinspiratory firing pattern of LC motoneurons became inspiratory after intravenous injection of strychnine (4 of 5 rats), but no change was recorded in response to strychnine iontophoresis (7 of 8 rats). CONCLUSIONS: Blockade of glycinergic inhibitory neurotransmission by strychnine, acting above the level of the LC motoneuron, causes LC motoneurons to fire during inspiration rather than after inspiration. This observation suggests that impaired glycine neurotransmission may be an underlying mechanism that explains the clinical manifestations of congenital bilateral vocal cord paralysis.

Animals↗
PubMed2005

Laser microsurgical bilateral posterior cordectomy for the treatment of bilateral vocal fold paralysis.

OBJECTIVES: We performed a prospective study to assess respiratory function and voice quality before and after laser microsurgical bilateral posterior cordectomy performed for chronic airway obstruction in patients with bilateral vocal fold paralysis. METHODS: In 17 patients a laser microsurgical posterior cordectomy was performed as an immediate bilateral approach. Roughness, breathiness, hoarseness, and dyspnea were evaluated both subjectively (on a scale from 0 to 3) and objectively (body plethysmography, computerized voice analysis: Göttingen Hoarseness Diagram). RESULTS: After laser surgery, the patients' respiratory function was significantly increased and was sufficient for all activities of daily living. The body plethysmographic measure of airway resistance had superior descriptive power and correlated significantly with the clinical degree of dyspnea (scale 0 to 3). Pretreatment and posttreatment impairment of voice quality was objectively documented with the Göttingen Hoarseness Diagram; the phonatory results measured with it correlated significantly with the subjective clinical evaluation of hoarseness. Aphonia did not occur. CONCLUSIONS: A bilateral approach for laser microsurgical posterior cordectomy combines excellent airway improvement and satisfactory voice preservation. In bilateral vocal fold paralysis, pretreatment and posttreatment clinical data should be evaluated by objective measures.

Activities of Daily Living↗
PubMedDate not supplied

Bilateral abductor vocal cord paralysis in Charcot-Marie-Tooth disease.

This report descirbes the unusual association of bilateral abductor vocal cord paralysis (BAbVCP) and Charcot-Marie-Tooth disease in a boy and his natural mother who have been followed for eight years. The boy initially presented with life-threatening respiratory distress at age ten years; BAbVCP was documented by direct laryngoscopy. Mirror laryngoscopy confirmed BAbVCP in the mother. Neurological diagnosis was made by history, physical examination, electromyography, and nerve conduction velocity studies. The BAbVCP may represent an additional genetic marker within the spectrum of heredodegenerative disorders. Of clinical importance is examination of voice and respiratory symptomatology of patients with heredodegenerative diseases and neurological work-up of patients with familial vocal cord paralysis. Further genetic and clinical studies of X cranial nerve involvement in heredodegenerative disorders are warranted.

Adolescent↗
PubMedDate not supplied

Congenital hereditary bilateral abductor vocal cord paralysis.

Congenital hereditary bilateral abductor vocal cord paralysis has been found in a father, his son and daughter. Though the disorder was previously believed to be inherited in a sex-linked manner, it now appears that there is an autosomal dominant variant. The vocal cord paralysis was associated with swallowing difficulty during infancy in all three of the family members. Although both the son and daughter required tracheostomies during the neonatal period, both manifested improvement of vocal cord movement during infancy so that decannulation was possible before 14 months of age. Localized delay in neurologic maturation is suspected as the etiology.

Age Factors↗
PubMedDate not supplied

An unusual form of laryngeal paralysis associated with Arnold-Chiari malformation.

This paper alerts the otolaryngologist to a previously unreported type of laryngeal paralysis (adductor type) in association with the Arnold-Chiari malformation. A survey of the literature fails to reveal any similar documented cases of absent laryngeal sensory function in association with this neurological defect. All prior reports have dealt with abductor laryngeal paralysis associated with the Arnold-Chiari malformation in which airway obstruction was the predominant laryngeal symptom. In the patient reported here, aspiration was the predominant symptom and was due to total loss of laryngeal sensation. This report describes this patient's clinical findings in detail, reviews the literature, and discusses management.

Arnold-Chiari Malformation↗
PubMedDate not supplied

Hereditary congenital laryngeal abductor paralysis.

We discuss the cases of a mother and daughter with paralysis of laryngeal abduction at birth as an isolated symptom. These patients are compared with other known families with congenital abductor paralysis, and inferences are made about the cause and mechanism of the disorder. A plan of diagnosis and management is presented.

Adult↗
PubMed1989

Effect of vocal fold augmentation on laryngeal vibration in simulated recurrent laryngeal nerve paralysis: a study of Teflon and Phonogel.

Flaccid laryngeal nerve paralysis may be treated by vocal fold augmentation with Teflon injection, which is successful to various degrees depending on the subjective interpretation of the patient or clinician. A new material, Phonogel, consisting of cross-linked bovine collagen, is available but not approved for human use in this area. Ten dogs were submitted to videostroboscopy, photoglottography, electroglottography, and acoustic analysis in the normal state, with stimulated recurrent laryngeal nerve paralysis, and with injection of either Teflon or Phonogel. A statistical comparison and the advantages and disadvantages of each material are discussed in relation to this study and its clinical use.

Animals↗
PubMed1989

Long-term results of nerve-muscle pedicle reinnervation for laryngeal paralysis.

Between 1976 and 1986, 214 patients with bilateral vocal fold paralysis and 73 patients with unilateral vocal fold paralysis were managed by the author using the nerve-muscle pedicle technique for reinnervation. Follow-up of at least 2 years has been obtained on 202 of the bilaterally and 70 of the unilaterally involved patients. Long-term success has been achieved in 74% of the bilateral group and 88% of the unilateral group. Successful reinnervation of unilateral paralyses usually maintains voice correction indefinitely, but there is late (2 to 5 years postsurgery) deterioration of successful airway restoration in approximately 17% of bilateral cases, which appears to be due to development of cricoarytenoid arthritis.

Follow-Up Studies↗
PubMed1989

Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis.

Upper airway obstruction due to bilateral vocal cord paralysis was successfully relieved by carbon dioxide laser posterior cordectomy. All patients achieved satisfactory airway and decannulation. Flow-volume loop spirograms obtained preoperatively and postoperatively documented improved flow rates on inspiration and expiration. Final voice quality was subjectively good in all patients. Follow-up has ranged from 1 year 10 months to 5 years 8 months, and initial improvement has been sustained in all cases. Carbon dioxide laser posterior partial cordectomy is an alternative management option for relief of upper airway obstruction due to bilateral vocal cord paralysis. The procedure can be performed without prophylactic tracheotomy. Subjectively good voice quality is preserved.

Adult↗
PubMed1990

Surgical treatment for laryngeal paralysis in infants and children.

Clinical and endoscopic data of 219 cases of laryngeal paralysis in newborns, infants, and children are briefly reported. The management of severe cases of persistent dyspnea then is discussed, according to the literature. Of 219 cases, 22 young patients underwent a surgical procedure because of lack of spontaneous recovery and poor tolerance of their disease after 6 to 9 months of follow-up. Arytenoidectomy technique has been used three times and arytenoidopexy 19 times, with fair to excellent results. Other possible treatments for infants are discussed. On the basis of this important series of surgical pediatric cases, the arytenoidopexy technique is advocated, besides arytenoidectomy, to avoid the risks of a long-term tracheostomy in young patients with vocal cord paralysis and severe dyspnea.

Adolescent↗
PubMed1992

Animal model for ischemic facial nerve paralysis with selective vascular embolization.

An experimental model that reliably and easily produces acute ischemic facial nerve paralysis would be useful for the controlled study of treatment and to improve our understanding of the pathophysiology and treatment of facial nerve palsy. Most documented models that simulate clinical facial nerve palsy cause direct damage to the nerve. We describe an experimental model for ischemic facial nerve paralysis in the cat that employs arterial block of the internal and external maxillary and posterior auricular arteries using embolizing material (Avitene). All animals develop stable acute ischemic facial nerve palsy lasting for approximately 2 months. Electromyographic study of this model revealed that the site of the lesion resulting from selective embolization may be within the temporal bone. This model has the advantages of simplicity of technique, cost-effective use of cats, and reproducibility of facial nerve palsy.

Animals↗
PubMed1996

Endoscopic laser medial arytenoidectomy versus total arytenoidectomy in the management of bilateral vocal fold paralysis.

Bilateral laryngeal paralysis can result in severe airway compromise. A widely accepted treatment is endoscopic laser total arytenoidectomy (TA); however, vocal results are usually poor. An alternative approach, resection of only the medial portion of the arytenoid (medial arytenoidectomy [MA]), has the potential for less vocal impairment, but may not provide a sufficient airway. Laryngeal resistance (LR) was measured in vivo and ex vivo in 12 adult mongrel dogs with bilateral laryngeal paralysis after TA, MA, or no surgery (controls). The LR was significantly lower than in controls in both TA and MA, but there was no significant difference between TA and MA. Glottic area was also significantly higher in both MA and TA compared to controls, but again, there was no significant difference between TA and MA. Phonation could be elicited in all controls and 2 of 4 dogs with MA, but no dogs with TA. Our results show that MA offers airway improvement similar to that with TA and also has the potential for better vocal function.

Animals↗
PubMed1990

Early diaphragmatic paralysis. In infants with genetic disorders.

Three infants with recently diagnosed genetic diseases presented with respiratory failure and required assisted ventilation. One infant had spinal muscular atrophy (Werdnig-Hoffmann disease), and two had acid maltase deficiency. The cause of the respiratory failure in all was diaphragmatic paralysis, and they became ventilator dependent. Early diaphragmatic paralysis must be considered as a manifestation of genetic neuromuscular disorders.

Female↗
PubMedDate not supplied

Current status of muscle biopsy in facial paralysis.

The six abnormalities found in pathologic muscle biopsies are described and discussed. Those changes which are indicative of nerve denervation or muscle regeneration are tabulated. Muscle biopsy, as it related to facial paralysis, must still be considered, for the most part, an experimental tool. In certain puzzling situations, eg, neonatal facial paralysis, it can be of value as an adjunct to nerve excitability and electromyographic tests.

Atrophy↗
PubMed1983

Laser arytenoidectomy for bilateral vocal cord paralysis.

The CO2 surgical laser was found to be a useful tool for the performance of endoscopic arytenoidectomy for bilateral vocal cord paralysis. The dog was found to be a less-than-perfect experimental model for human bilateral abductor vocal cord paralysis. Documentation by measurements of arterial blood gases and direct in vivo measurements of airway resistance following bilateral recurrent laryngeal nerve section and endoscopic arytenoidectomy was attempted.

Airway Resistance↗
PubMed1983

Bilateral facial nerve paralysis following arterial embolization for epistaxis.

Risk of carotid artery embolization is usually attributed to inadvertent occlusion of the internal carotid system. This report highlights some recently noted complications associated with occlusion of external carotid branches. A case of bilateral facial paralysis following embolization of the internal maxillary arteries for severe epistaxis is presented. The clinician must recognize that facial paralysis is a real and sometimes inevitable sequela to the ever-increasing practice of arterial embolization in the head and neck.

Arteries↗