Laryngology Flashcards
Approximately what percent of patients with bilateral vocal cord paralysis never require tracheostomy?
50%.
In what percent of patients with bilateral vocal cord paralysis is decannulation possible after one of these procedures?
70%.
When is medialization thyroplasty appropriate for the treatment of vocal cord paralysis?
Any stable, definitive paralysis in a patient without surgical contraindications.
What substances can be used for temporary vocal cord medialization?
Autologous fat, Gelfoam, collagen, and micronized Alloderm.
What are the advantages of performing this procedure under local?
Desired voice quality can be precisely obtained and airway can be continually evaluated.
What are the indications for endolaryngeal stenting after open repair of laryngeal injuries?
Disruption of the anterior commissure; multiple displaced cartilage fractures; and multiple, severe lacerations.
What symptom, other than hoarseness, is most likely to be improved by medialization thyroplasty and arytenoid adduction?
Dysphagia.
What are the two primary techniques of laryngeal reinnervation?
End-to-end anastomosis of the recurrent laryngeal nerve to the ansa hypoglossi or nerve-muscle pedicle flap to the thyroarytenoid muscle (using the ansa and a small piece of strap muscle).
What is the most likely cause of prolonged dysphonia and vocal fold stiffness after surgery for Reinke’s edema?
Excessive suctioning of the superficial lamina propria.
True/False: Previous Teflon injection is a contraindication to medialization thyroplasty.
False.
True/False: When injecting Teflon in the vocal fold, it should be placed as far medially as possible.
False: It should be placed as far laterally as possible.
What is the most common immediate complication after repair of laryngeal injuries?
Granulation tissue.
What is the most common complication after insertion of a Blom-Singer indwelling voice prosthesis?
Granulation tissue.
What is the primary disadvantage of the indwelling voice prosthesis compared with the nonindwelling prosthesis?
Higher rate of fungal colonization.
Which laryngoscopes are best for visualizing the anterior commissure or the subglottis?
Holinger and Benjamin.
A 69-year-old man with terminal lung cancer has severe hoarseness secondary to left vocal cord paralysis. What would be the best treatment option?
Left vocal cord medialization with Teflon paste.
What are the four main categories of procedures for unilateral vocal cord paralysis?
Medialization thyroplasty, arytenoid adduction, intracordal injection, and laryngeal reinnervation.
What would be the best treatment for a 6o-year-old woman who experiences severe dysphagia and aspiration after removal of a high right vagal schwannoma?
Right medialization thyroplasty, arytenoid adduction.
What is the optimal treatment for presbylaryngeus?
Speech therapy for 1year; if that fails, then bilateral medialization thyroplasty.
Into which plane is the implant placed during medialization thyroplasty?
Subperichondrial.
What is the aim of laryngeal reinnervation?
To prevent atrophy of the thyroarytenoid muscle.
What is the aim of arytenoid adduction?
To pull the muscular process of the arytenoid laterally, resulting in adduction and lowering of the vocal process.
What are five ways to restore the airway in patients with bilateral vocal fold paralysis?
Tracheostomy, stitch lateralization of the arytenoid(s), laser arytenoidectomy, unilateral or bilateral laser cordectomy.
True/False: Arytenoid adduction is contraindicated for the treatment of presbylaryngeus.
True: Arytenoid adduction is contraindicated in any patient with mobile vocal folds.