Vocal Fold Paralysis

by Sulica, Lucian; Blitzer, Andrew

• ISBN13: 9783540237655
• ISBN10: 3540237658
• Format: Hardcover
• Copyright: 2006-04-15
• Publisher: Springer Verlag

Summary

New therapeutic options and approaches have been developed based on an expanded knowledge of the underlying pathophysiology of vocal fold paralysis. The core of Vocal Fold Paralysis offers step-by-step descriptions and of the following therapies: vocal fold injection, medialization laryngoplasty, and arytenoid repositioning surgery. It also includes special topics such as reinnervation, vocal fold pacing, bilateral medialization, and pediatric and bilateral vocal fold paralysis. Vocal Fold Paralysis is a clinically useful reference for evaluation and treatment, as well as a summary of current knowledge and investigational approaches. This excellent guide fills a void within the field of otolaryngology and should not be missed by any otorhinolaryngologist, neurologist, phoniatrician or speech pathologist.

Table of Contents

Part I Basic Science and Clinical Evaluation
Chapter 1 Neuroanatomy of the Larynx
Ajay E. Chitkara
Introduction	3	(1)
CNS	4	(1)
Superior Laryngeal Nerve	4	(2)
Cervical Segment of SLN	5	(1)
Internal Branch of SLN	5	(1)
External Branch of SLN	5	(1)
Recurrent Laryngeal Nerve	6	(6)
Cervical Segment of RLN	6	(1)
RLN Branching Patterns	7	(1)
Relationship of RLN with Inferior Thyroid Artery	8	(2)
Retrothyroid Segment of RLN	10	(1)
Laryngeal Segment of RLN	10	(2)
Neuromuscular Junctions	12	(1)
RLN Communication with SLN	12	(2)
Conclusion	14	(3)
Chapter 2 Synkinesis and Dysfunctional Reinnervation of the Larynx
David L. Zealear, Cheryl R. Billante
Introduction	17	(1)
Innervation and Functional Anatomy of Laryngeal Muscles	17	(4)
Consequence of RLN Injury	21	(3)
Conventional Treatment for Laryngeal Paralysis	24	(1)
Studies in Selective Reinnervation	25	(8)
Chapter 3 Vocal Fold Paralysis: Causes, Outcomes, and Clinical Aspects
Lucian Sulica, Anthony Cultrara, Andrew Blitzer
Introduction	33	(1)
Sources of Nerve Damage	33	(15)
Overview	33	(5)
Surgery/Trauma	38	(1)
Surgery in the Neck	38	(1)
Surgery in the Chest	44	(1)
Surgery at the Skull Base	45	(1)
Other Procedures and Interventions	45	(1)
Medical Disease	46	(1)
Malignancy	46	(1)
Nonmalignant Disease	46	(1)
Stroke	47	(1)
Other Neurologic Disease	47	(1)
Idiopathic Vocal Fold Paralysis	47	(1)
Conclusion	48	(7)
Chapter 4 Evaluation of Vocal Fold Paralysis
C. Blake Simpson, Esther J. Cheung
History	55	(2)
Vocal Quality and Swallowing	55	(1)
Vocal Inventory	55	(1)
Airway	56	(1)
Medical History: Establishing an Etiology	56	(1)
Physical Examination	57	(2)
General	57	(1)
Laryngeal	57	(2)
Work-up	59	(2)
Serology	59	(1)
Imaging Studies	59	(2)
Conclusion	61	(2)
Chapter 5 Diagnostic Electromyography for Unilateral Vocal Fold Dysmotility
Al Hillel, Lawrence Robinson
Introduction	63	(1)
Definition of Immobility	63	(1)
Definition of Electromyography	63	(1)
Techniques of Electromyography	64	(1)
EMG Waveforms: How They Are Derived, and What They Mean	64	(2)
How LEMG Defines Dysmotility and Refines the Diagnosis	66	(3)
How LEMG Can Guide Treatment	69	(1)
Philosophy of LEMG	70	(1)
Case Examples	70	(7)
Case 1	70	(1)
Case 2	70	(7)
Part II Treatment
Chapter 6 Decision Points in the Management of Vocal Fold Paralysis
Lucian Sulica, Andrew Blitzer
Introduction	77	(1)
Dysphagia and Aspiration	77	(1)
Prognosis	78	(2)
Laryngeal Electromyography	80	(1)
Adjusting the Treatment Algorithm	81	(2)
Conclusion	83	(4)
Chapter 7 Voice Therapy for Unilateral Vocal Fold Paralysis
Celia F. Stewart, Elizabeth Allen
Introduction	87	(1)
Assessment	87	(2)
Perceptual Assessment	87	(1)
Self-Ratings	87	(1)
Objective Measurements	88	(1)
Compensations	89	(1)
Guidelines for Planning Voice Therapy	89	(1)
Patterns of Vocal Symptoms	90	(1)
Rehabilitation Hypotheses	90	(1)
Therapy Procedures	90	(3)
Indirect Rehabilitation	90	(1)
Direct Rehabilitation	91	(1)
Transfer of Skills	92	(1)
Vocal Practice	92	(1)
Communicating in Noisy Environments	92	(1)
Results	93	(1)
Conclusion	93	(4)
Chapter 8 Injection Augmentation
Karen A. Cooper, Charles N. Ford
Introduction	97	(1)
Indications	97	(1)
Historical Note	97	(1)
Timing of Intervention	98	(1)
Technique	99	(1)
Office-Based Procedure	99	(3)
Results	102	(1)
Complications	102	(1)
Current Status and Future Goals	102	(3)
Chapter 8.1 Autologous Fat for Vocal Fold Injection
Clark A. Rosen
Introduction	105	(1)
Rationale for Vocal Fold Lipoinjection	105	(1)
Patient Selection	105	(1)
Technical Aspects of Vocal Fold Lipoinjection	106	(1)
Fat Harvest	106	(1)
Lipoinjection	108	(1)
Post-operative Care Following Lipoinjection	108	(1)
Duration of Benefit	109	(1)
Complications of Lipoinjection of the Vocal Folds	109	(1)
Airway	109	(1)
Suboptimal Voice Improvement	109	(1)
Overinjection	110	(1)
Chapter 8.2 Collagen in Vocal Fold Injection
Mark S. Courey
Physiologic Considerations	111	(1)
Historical Considerations	111	(1)
Technical Considerations	112	(2)
Clinical Applications	114	(1)
Conclusion	114	(3)
Chapter 8.3 Treatment of Glottal Insufficiency Using Micronized Human Acellular Dermis (Cymetra)
Albert L. Merati
Introduction	117	(1)
Background	117	(1)
Advantages and Disadvantages of Micronized Acellular Dermis for Clinical Use	118	(1)
Micronized Human Acellular Dermis in Clinical Laryngology	119	(1)
Complications	119	(1)
Technical Aspects for Using Micronized Acellular Human Dermis	120	(1)
Conclusion	120	(3)
Chapter 8.4 Vocal Fold Augmentation with Calcium Hydroxylapatite
Peter C. Belafsky, Gregory N. Postma
Introduction	123	(1)
Indications for Vocal Fold Augmentation with CaHA	123	(1)
Technique of Injection Augmentation with CaHA	123	(1)
In-Office Injection of CaHA	124	(1)
Injection of CaHA in the Operating Room	124	(2)
Conclusion	126	(1)
Chapter 8.5 Treatment of Glottal Insufficiency Using Hyaluronan
Stellan Hertegåd, Åke Dahlqvist, Lars Hallén, Claude Laurent
Introduction and Core Messages	127	(1)
Rationale	128	(1)
Indications	128	(1)
Indication Under Investigation	129	(1)
Patient Selection	129	(1)
Advantages	130	(1)
Disadvantages	131	(1)
Complications	131	(1)
Technique	131	(4)
Chapter 9 Principles of Medialization Laryngoplasty
C. Blake Simpson, Lucian Sulica
Introduction	135	(1)
Indications for Surgery	135	(2)
Arytenoid Adduction	137	(1)
Procedure Selection: Framework Surgery vs Injection Augmentation	137	(1)
Patient Selection	137	(1)
Timing of Medialization Laryngoplasty	138	(1)
Technical Notes and Pertinent Anatomic Landmarks	138	(2)
Complications	140	(1)
Suboptimal Results/Surgical Errors	141	(1)
Revision Surgery	142	(1)
Long-Term Surgical Issues	142	(1)
Conclusion	142	(3)
Chapter 9.1 Silastic Medialization Laryngoplasty
C. Blake Simpson
Introduction	145	(1)
Procedure	145	(1)
Preparation	145	(1)
Surgical Approach	145	(1)
Endolaryngeal/Paraglottic Manipulation	146	(1)
Carving the Silastic Implant	147	(1)
Implant Insertion	148	(1)
Closure	150	(1)
Postoperative Care	150	(1)
Postoperative Issues and Expected Vocal Recovery	150	(3)
Chapter 9.2 Medialization Thyroplasty Using the Montgomery Thyroplasty System
Mark A. Varvares, Rebecca M. Brandsted
Introduction	153	(1)
Design of Thyroplasty Prosthesis	153	(1)
Patient Selection	154	(1)
Anesthesia	154	(1)
Surgical Technique	154	(1)
Window Measurement	155	(1)
Window Outline	155	(1)
Method for Cutting Window	156	(1)
Implant Measurement	156	(1)
Insertion of Implant	157	(1)
Closure	157	(1)
Postoperative Care	157	(1)
Complications	157	(1)
Results	157	(1)
Conclusion	158	(1)
Chapter 9.3 Medialization Thyroplasty Using the VoCoM Vocal Cord Medialization System
Tanya K. Meyer, Andrew Blitzer
Introduction	159	(1)
Surgical Technique	160	(3)
Revision	163	(1)
Complications	163	(1)
Results	163	(1)
Conclusion	163	(2)
Chapter 9.4 Titanium Medialization Implant
Berit Schneider
Titanium as a Biomaterial	165	(1)
Titanium Vocal Medialization Implant	165	(1)
Preoperative Medication	166	(1)
Anesthesia	166	(1)
Surgical Technique	166	(1)
Objective Outcome Measures	167	(1)
Advantages	167	(1)
Complications	167	(1)
Other Titanium Implant Devices	168	(1)
Chapter 9.5 Medialization Laryngoplasty with Gore Tex (Expanded Polytetrafluoroethylene)
Timothy M. McCulloch, Henry T. Hoffman
Introduction	169	(1)
Technique of Gore Tex Thyroplasty	170	(1)
Patient Preparation Steps	171	(1)
Operative Steps	171	(3)
Complications	174	(1)
Conclusion	175	(2)
Chapter 10 Arytenoid Repositioning Surgery
Gayle E. Woodson
Introduction	177	(1)
Indications	177	(1)
Vocal Fold Motion	178	(1)
What Is a Posterior Gap?	178	(1)
History of Arytenoid Surgery	179	(1)
Mechanics of Arytenoid Surgery	180	(1)
Technique of Arytenoid Adduction	181	(3)
Conclusion	184	(5)
Part III Special Topics
Chapter 11 Laryngeal Reinnervation
Randal C. Paniello
Introduction	189	(1)
Rationale for Reinnervation in UVFP	189	(1)
Choice of Donor Nerve	190	(1)
Choice of Anesthesia/Contingency Plans	191	(1)
Technique of Ansa Cervicalis to RLN Anastomosis	192	(1)
Technique of Hypoglossal Nerve to RLN Anastomosis	193	(1)
Postoperative Care	194	(1)
Results of Animal Studies	194	(1)
Clinical Results	195	(2)
Ansa-RLN	195	(1)
Ansa-RLN and Medialization	195	(1)
Hypoglossal Nerve	196	(1)
Original RLN	196	(1)
Reinnervation or Medialization?	197	(1)
Cricothyroid Reinnervation	197	(1)
Abductor Reinnervation	198	(1)
Phrenic Nerve	198	(1)
Ansa Cervicalis	199	(1)
Combined Adductor and Abductor Reinnervation	199	(1)
Bidirectional Motion: Animal Models	199	(1)
Reinnervation for Laryngeal Transplantation	199	(1)
Conclusion	200	(3)
Chapter 12 Electrical Stimulation for Vocal Fold Paralysis
Michael Broniatowski
Introduction	203	(1)
Background and Justification	203	(4)
The Problem	203	(1)
Critique of Traditional Management of Laryngeal Paralyses	204	(1)
Physiological Bases for Laryngeal Stimulation	204	(1)
Challenges in Approaches to Laryngeal Stimulation	205	(2)
Laryngeal Stimulating Strategies	207	(1)
Issues of Long Term Stimulation and Biocompatibility of Implanted Circuits	207	(1)
Current Human Applications	207	(5)
Dynamic Laryngotracheal Closure for Aspiration	208	(1)
Dynamic Restoration of Laryngeal Patency After Bilateral Vocal Fold Paralysis	209	(3)
Potential Future Human Applications	212	(3)
Integrated Swallowing Rehabilitation	213	(1)
Laryngeal Transplantation	213	(1)
Artificial Control of Voice and Spasm	213	(2)
Conclusion	215	(4)
Chapter 13 Bilateral Medialization Laryngoplasty
Gregory N. Postma, Peter C. Belafsky
Introduction	219	(1)
Surgical Indications	219	(1)
Surgical Technique	219	(3)
Results	222	(1)
Complications	222	(1)
Discussion	222	(1)
Approach to Surgical Treatment	223	(1)
Conclusion	223	(2)
Chapter 14 Vocal Fold Paralysis in Children
Marshall E. Smith
Introduction	225	(1)
Spectrum of Presentation	225	(1)
The Newborn and Infant: Airway and Swallowing Assessment and Management	226	(1)
Management of Airway, Voice, and Swallowing in Vocal Fold Paralysis in Infants	227	(1)
Bilateral Vocal Fold Paralysis: Long-Term Management Options	228	(1)
Voice Concerns in the Older Child and Adolescent	229	(1)
Unilateral Laryngeal Paralysis: Management Options	230	(1)
Laryngeal EMG in Children	231	(1)
Familial Vocal Fold Paralysis	232	(1)
Conclusion	232	(5)
Chapter 15 Bilateral Vocal Fold Immobility
George Goding
Introduction	237	(1)
History	237	(1)
Etiology	238	(1)
Evaluation	239	(1)
Adjunctive Measures and Nonsurgical Management	240	(1)
Surgical Management	241	(1)
Posterior Glottic Stenosis	241	(1)
Direct Muscle Reinnervation	242	(1)
Lateralization	243	(1)
Tissue Removal	244	(1)
Research	245	(1)
Conclusion	246	(3)
Subject Index	249