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Laryngeal reinnervation in unilateral vocal fold paralysis- case report and literature review

100%
Rzepakowska A., Jachimowska J., Niemczyk K.
Polski Przegląd Otorynolaryngologiczny
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2017
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vol. 6(2)
36-41
EN
Laryngeal reinnervation is the method of treatment in unilateral vocal fold paralysis. During the surgery an anastomosis between the main branch of ansa cervicalis and recurrent laryngeal nerve is formed. Regeneration of the nerve’s functional abilities is a long process, lasting from 4 to 6 months, up to a year. A 35 year-old male was admitted to the Department of Otolaryngology at Warsaw Medical University in order to undergo surgical removal of reoccurrence of Schwannoma in left cerebellopontine angle by translabyrinthine approach. Post-operative period was complicated with vagal nerve paralysis. The patient reported hoarseness, dysphagia and choking. Physical examination revealed left vocal fold immobilization in abducted position, saliva in piriform fossa and left-sided soft palate paralysis yet the patient was discharged home. 4 weeks after the surgery, the patient was admitted to the hospital again due to developing aspiration pneumonia. Augmentation of the left vocal fold with calcium hydroxyapatite was performed 2 months later. After this intervention temporary vocal improvement and choking frequency reduction was observed. Finally, the patient underwent laryngeal reinnervation with formation of ansa cervicalis main branch to recurrent laryngeal nerve anastomosis. Left vocal fold regained its functional abilities and the quality of the voice improved. Laryngovideostroboscopy performed 6 months later revealed mobilization of left vocal fold sufficient for proper glottis closure. The voice measures normalized and the swallowing improved. Conclusions This case report and analyzed data confirm that laryngeal reinnervation surgery in unilateral vocal fold paralysis helps achieve satisfactory effects in voice function and life quality.
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Medialization thyroplasty in glottis insufficiency due to unilateral vocal fold paralysis and after laser cordectomies – preliminary report

88%
Rzepakowska A., Osuch-Wójcikiewicz E., Sielska-Badurek E., Niemczyk K.
Otolaryngologia Polska
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2017
|
vol. 71(1)
22-29
EN
Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy. The aim: The evaluation of voice results in patients after medialisation throplasty. Material and methods: In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma. Results: There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement. Conclusions: The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.
3
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Medialization thyroplasty in glottis insufficiency due to unilateral vocal fold paralysis and after laser cordectomies – preliminary report

88%
Rzepakowska A., Osuch-Wójcikiewicz E., Sielska-Badurek E., Niemczyk K.
Polish Journal of Otolaryngology
|
2017
|
vol. 71
|
issue 1
22-29
EN
Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy. The aim: The evaluation of voice results in patients after medialisation throplasty. Material and methods: In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma. Results: There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement. Conclusions: The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.
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