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Sat, 13 Jul 2019 | Vocal Fold
Paralysis, abdominal hernia repair, and post-parotidectomy rehabilitation, to name a few. By design, the structure of the acellular dermis is to provide a scaffold upon which ingrowth of tissue and neovascularity occurs. This has been demonstrated in the rabbit abdominal wall model 6 , Little histological information about the fate of the micronized material is available, however. It has been concluded from a randomized prospective clinical trial studying lip augmentation that the cumulative...
Thu, 06 Jun 2019 | Vocal Fold
Decisions regarding therapeutic intervention in cases of vocal fold paralysis are guided by concerns regarding morbidity, principally from dysphagia and aspiration, and expectations and assumptions about the eventual outcome for the patient if left untreated. In turn, expectations concerning prognosis are influenced by the apparent cause of the paralysis and the time that has elapsed since onset. Electrophysiologic testing, in the form of laryngeal electromyography, has also been used to...
Other Procedures and Interventions
Wed, 02 May 2018 | Vocal Fold
Vocal fold paralysis occasionally follows surgery that does not place the nerve at risk. Such cases have been occasionally attributed to cricoarytenoid dislocation, but damage to this well-supported joint has been shown by anatomical study to be extremely unlikely 52,53 , especially when no note was made of difficulty at intubation. Careful dissection has shown that the anterior branch of the recurrent laryngeal nerve is subject to compression between a high-riding endotracheal tube cuff and...
RLN Communication with SLN
Sat, 02 Dec 2017 | Vocal Fold
The interrelationship of the RLN with the SLN has been noted since the first century A.D. when Galen described his eponymous anastomosis 19 . The present controversy over these anastomoses is not whether they exist, but whether they contain motor fibers, sensory fibers, or both. During the twentieth century various authors supported and disputed the motor communication based upon anatomical and physiological studies. Contemporary research convincingly shows that there is more than one site of...
Mon, 24 Jul 2017 | Vocal Fold
Back pressure during articulation of consonants. During production of consonants pressure is generated supraglottally by the closure of the vocal tract. This pressure increases the subglottal pressure that is necessary to generate vibration of the vocal folds. Consequently, the subglottal pressure must exceed the pressure from the medial compression of the vocal folds and the supraglottal pressure so that vibration will occur munication. Voice disorders have long been associated with...
Tue, 02 Feb 2016 | Vocal Fold
Zaretsky L, Sanders I (1992) The three bellies of the canine cricothyroid muscle. Ann Otol Rhinol Laryngol (Suppl) 156 3-16 2. Sanders I, Jacobs I, Wu, Biller HF (1993) The three bellies of the canine posterior cricoarytenoid muscle implications for understanding laryngeal function. Laryngoscope 103 171-177 3. Sanders I, Bei-Lian W, Liancai M, Biller HF (1994) The innervation of the human posterior cricoarytenoid muscle evidence for at least two neuromuscular compartments. Laryngoscope 104...
Vocal Fold Augmentation with Calcium Hydroxylapatite
Sun, 31 Jan 2016 | Vocal Fold
Postma Synthetic calcium hydroxylapatite (CaHA Radiesse, BioForm, Franksville, Wis.) was approved for vocal fold augmentation by the United States Food and Drug Administration (FDA) Center for Devices and Radiological Health in January 2002. Calcium hydroxylapatite is the primary mineral constituent of bone and teeth. The substance has a proven track record of being highly biocompatible 1-6 . The laryngeal implant is created by suspending CaHA spherules in a gel...
Xomed Silastic Block
Tue, 26 Jan 2016 | Vocal Fold
Silicone elastomer, commonly referred to as Silastic, is a polymerized form of silicone gel. Silastic is inert material which is well tolerated when implanted into the human body. A long track record of Silastic use exists (mostly in the orthopedic literature), and approximately 25 years of experience have accumulated for its use in the larynx 1 . Silastic can be used successfully as a long-term material for glottic insufficiency in both immobile and mobile vocal folds. Type-I allergic...
Superior Arcuate Line Vocal Fold
Fri, 18 Dec 2015 | Vocal Fold
Vocal fold injection for global augmentation of the vocal fold is a successful way to treat glottal closure insufficiency 1 . Autologous fat is an excellent material for this type of vocal fold injection. This chapter discusses the patient selection, clinical aspects, and post-operative management issues related to vocal fold lipoin-jection. RationaleforVocal Fold Lipoinjection The distinct advantage of vocal fold lipoinjection is the use of an autologous material that is usually readily...
Many motor units firing slowly indicating concern for a central deficit. Note that the recruitment pattern is not as full as in Fig. 5.5, and that the motor units do not seem to be rapidly repetitive as in Fig. 5.5. This condition is characterized as many motor units firing slowly. 2. A severe peripheral nerve injury with a few motor units, usually firing fast 3. A moderate peripheral nerve injury with many motor units but decreased recruitment These four groups can further be...
Subglottic Jet Ventilation
Thu, 27 Aug 2015 | Vocal Fold
Each package ofRadiesse contains 1 cc of implant in a Luer-Lok syringe Radiesse can be injected percutaneously either through the cricothyroid membrane or directly through the thyroid cartilage under transnasal fiberoptic laryngoscopy (TFL) guidance. The CaHA can also be injected in the office setting per-orally through a curved laryngeal needle. Anesthesia can be achieved with a combination of superior laryngeal nerve blocks and an instillation of 2 cc of 1 lidocaine into the...
Tue, 18 Aug 2015 | Vocal Fold
The appropriate-size window caliper is used to measure from inferior border of thyroid cartilage, anterior and posterior to inferior thyroid tubercle, to superior border of thyroplasty window. A line is extended anteriorly through these points. The key point is then measured with the same caliper from anterior midline of thyroid cartilage, marking the anterior-superior angle of thyro-plastywindow. (From 2 ) (Fig. 9.2.2) and is carefully elevated form the...
Success Rate Of Gore Tex Thyroplasty
Mon, 27 Apr 2015 | Vocal Fold
Surgical correction of arytenoid position is an effective means of managing patients with posterior glottic incompetence due to laryngeal paralysis 1-3 . Many surgeons avoid arytenoid procedures because they perceive this approach to be difficult and fraught with complications 4 . Additionally, most patients with laryngeal paralysis respond to either injection augmentation or open thyroplasty however, persisting posterior gap is a common reason for failure of medialization procedures. A review...
Conventional Treatment for Laryngeal Paralysis
Tue, 07 Oct 2014 | Vocal Fold
Decisions regarding intervention in cases of vocal fold paralysis are made on the basis of the laryngeal function that is most compromised. In the case of unilateral paralysis, the voice is breathy and the patient is at risk for aspiration due to compromised adduction. Inspiratory capacity is minimally impaired, as abduction of the opposite vocal fold provides adequate ventilation. In bilateral paralysis, the gravest concern is total loss of abduction. Because the vocal folds are paralyzed in...
RLN Branching Patterns
Wed, 18 Jun 2014 | Vocal Fold
Inferior laryngeal nerve crosses posterior to the common carotid artery and enters the larynx posterior to the CT joint 13 . This aberrant pathway is explained by abnormal embryo-logical development. Normally, the recurrent laryngeal nerves are pulled caudad in the neck and chest around the sixth arches of the aorta. The left sixth arch remains as the ductus arteriosus, and later the ligamentum arteriosum. The right sixth arch normally resorbs, allowing the right RLN to pass inferior to the...
Medialization Laryngoplasty with Gore Tex Expanded Polytetrafluoroethylene
Mon, 24 Mar 2014 | Vocal Fold
Hoffman Although the ideal implant material for medialization laryngoplasty has not been defined, there has been increased enthusiasm for the utilization of expanded polytetrafluoroethylene or Gore-Tex as the implant of choice in the treatment of unilateral vocal cord paralysis. This material has many advantages not found in solid implant types however, there is more to Gore-Tex medialization laryngoplasty than simply an alternative implant material. The technique...
Kurz Titanium Thyroplasty Prosthesis
Wed, 05 Feb 2014 | Vocal Fold
Titanium Ti, anatomic number 22 was a laboratory rarity until William Kroll 1889-1973 developed a process for commercial production of titanium alloys by combining titanium tetrachloride with calcium to produce ductile titanium the Kroll Process . Titanium is the fourth most abundant structural metal on Earth. Today, it is widely used in medical devices, dental applications, and surgical implants due to its superior biological performance. About as strong as steel, titanium is 50 lighter. Its...
Innervation and Functional Anatomy of Laryngeal Muscles
Thu, 16 May 2013 | Vocal Fold | 1 comment
As a matter of basic orientation, a conventional view of laryngeal anatomy is briefly presented. The intrinsic laryngeal muscles have both their origin and insertion on the cricoid, thyroid, or arytenoid cartilage. In concert, they orchestrate the motion of the vocal folds during respiration, vocalization, and airway protection. The paired posterior cricoarytenoid PCA muscles are situated on the posterior larynx Fig. 2.1A . When the PCA contracts, it rocks the arytenoid cartilage in a...
Treatment ofGlottal Insufficiency Using Hyaluronan
Tue, 14 May 2013 | Vocal Fold
Stellan Herteg rd, ke Dahlqvist, Lars Hall n, Claude Laurent The main things to be understood about hyaluronan are as follows Hyaluronan hyaluronic acid, HA is a linear polysaccharide ubiquitous in all mammals which is naturally present in tissues, including the vocal folds. Hyaluronan is non-toxic, non-antigenic, non-inflammatory and is involved in many biological actions, such as wound healing and anti-adhesion. Hyaluronan binds water, regulates tissue osmosis and exerts viscoelasticity....
Consequence of RLN Injury
Mon, 06 May 2013 | Vocal Fold
Acute temporary laryngeal paralysis known as neurapraxia may be more common than indicated by patient numbers, as it resolves quickly within days or weeks. The paralysis stems from loss of signal conduction due to demyeliniza-tion without disruption of axons. Full recovery follows remyelinization by Schwann cells. Rehabilitation may take longer in case of axo-notmesis e.g., nerve crush , where the injury is severe enough to anatomically disrupt axons. Recovery ensues because regenerating axons...
The VoCoM Vocal Cord Medialization System
Thu, 02 May 2013 | Vocal Fold
The VoCoM thyroplasty method 1 is a self-contained system of implants and instruments to allow accurate vocal fold medialization. The VoCoM system can provide membranous vocal fold medialization in addition to moderate medialization of the vocal process of the arytenoid. The implants come in five sizes, and are secured with one of four shims allowing placement of the implant in several different positions. Specifically, the implant can be secured in a horizontal or vertical orientation, with...
Relationship of RLN with Inferior Thyroid Artery
The recurrent laryngeal nerve's intimate course with the inferior thyroid artery has long been the subject of anatomists endeavors in an effort to simplify the surgical approach and technique. Unfortunately, the course of the RLN as it relates to the inferior thyroid artery does not lend itself to broad and safe generalizations. Historically, the left RLN is described coursing deep to the inferior thyroid artery ITA in the majority of cases, and the right RLN passing deep to, superficial to, or...
Medialization Thyroplasty Using the Montgomery Thyroplasty System
Fri, 18 May 2012 | Vocal Fold
Brandsted The Montgomery Thyroplasty Implant System was developed in order to simplify the implant technique while providing both anterior and posterior vocal cord medialization 1,2 . Its design advantages include A readily available implant in varying sizes, thus bypassing the necessity to fashion or alter the implant material Specially designed measuring tools to facilitate localization of the thyroid window The use of an implant measuring device, so that the...
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