Vocal Fold Paralysis

Surgery for paralysis of the vocal folds

When both the vocal fold are paralysed and stay in the midline (abductor paralysis), the person has no space for breathing and this is an emergency situation. It is important to find out the cause of this paralysis and the patient needs an emergency tracheostomy (opening made in the airway through the neck with the insertion of a tracheostomy tube).If this condition does not spontaneously improve in 6-8 months various surgeries can be performed to create space for breathing. Using the CO2 laser to make an opening in the vocal fold or the arytenoids is a very effective surgery to restore the airway called laser cordectomy or laser arytenoidectomy.

Laser Arytenoidectomy Surgery For Bilateral Vocal Fold Paralysis

If both the vocal fold are paralysed but lie apart(adductor paralysis), the patient has ample space to breath but no voice. Furthermore, liquids tend to easily slip into the airway on attempted swallowing. This is called aspiration and necessitates a tracheostomy in the patient.

Unilateral Vocal Fold Paralysis (UVFP).

One of the vocal folds can become paralysed for a number of reasons. These include:

• External Trauma(vehicular accidents, strangulation)
• Surgical trauma(Thyroid surgery, cancer of food pipe surgery, heart surgery, neck tumour surgery, neck spine surgery)
• Cancer
• Benign swellings
• Viral and bacterial infections
• Idiopathic

The patient of UVFP has a gap between the vocal folds resulting in a breathy voice and occasional aspiration of liquids. A new breath has to be taken constantly in between words (air hunger) resulting in vocal fatigue.

In this situation, as one vocal fold is moving, voice therapy exercices are given to make the moving vocal fold work even harder and close the gap (compensation exercices)

In the eventuality that the voice does not improve with voice therapy or spontaneous recovery, surgery is recommended. One of the commonest surgeries is thyroplasty where a silastic implant is used to push the paralysed vocal fold medially. If the posterior gap is large then a special stitch called arytenoid rotation or adduction is required.

Vocal Fold Paralysis - 1	Vocal Fold Paralysis - 2	Vocal Fold Paralysis - 3
Pre operative Rigid Telelaryngoscopy of a patient with left vocal fold paralysis.	Post operative Rigid Telelaryngoscopy of same patient with left vocal fold medialised with a Silastic implant.	Video Animation of medialisation Thyroplasty with arytenoid rotation surgery.