Chapter 76 - Vocal Fold Paralysis Flashcards
Image to obtain if unexplained unilateral VC paralysis
CT w/ contrast of neck SB –> aortic arch
How sx of unilat vs bilat VC paralysis differ
Uni: hoarse, dysphagia, dyspnea with speaking. No dyspnea with exercise
Bilat: May have NL voice and swallow, or have dyspnea on exertion, inspiratory stridor
After how many months is paresis unlikely to recover
6mo after insult
Treatment of bilateral VC paralysis
enlarge airway (may sacrifice voice) by removing or lateralizing VC tissue
Laryngeal EMG findings with denervation and reinnervation
De: fibrillation potentials, positive waves
Rei: polyphasic motor units
does timing of TVF augmentation matter with TVF immobility?
yes, early augmentation in Sx patients offers better long term outcomes, decreased need for permanent augmentation
Rima glottis
where TVF meet during phonation
1cm below this is where subglottis begins
Vocalis muscle vs thyroarytenoid muscle
Vocalis is the medial portion of the thyroarytenoid muscle
Inf/Sup extent of conus elasticus
cricoid –> vocal ligament
which two structures does the cricothyroid muscle bring closer together
cricoid
thyroid
this lengthens the TVF
At what level does a non-recurrent laryngeal nerve come off on the right?
thyroid gland
RLN on left passes under which structure?
ligamentum arteriosum (was ductus arteriosus)
paralysis vs paresis
immobility vs hypomobile
immobile: lack of movement from any cause, not yet designated as permanent
hypomobile: partial movement, yet to be designated as permanent
paresis: hypomobility that is >6mo old, no other mechanical explanation, so a permanent neurologic cause
paralysis: immobility from permanent neurologic cause
In which gender is a posterior glottic gap often physiologic and normal?
female
which joint dislocation can give you an immobile TVF?
cricoarytenoid
When to do laryngeal EMG after onset of VC paralysis
3 weeks after injury
repeat 2 mo later
Materials used for > 6 mo injection laryngoplasty
calcium hydroxy
micronized dermis
hyaluronic acid
autologous fat (the only permanent one)
which is better for large glottic gaps, injection or medialization?
medialization
Into which space do you inject for injection laryngoplasty? What about medialization?
deep into TA muscle
paraglottic space
when to do arytenoid adduction +/- arytenopexy
large posterior gap
mismatch of height of vocal processes of arytenoid cart
how to acutely treat bilateral VC immobility
suture lateralization or trach
both are reversible
