Arytenoid lateralization with a simple suture in bilateral vocal cord paralysis HAKAN KORKMAZ MD suture in bilateral vocal cord paralysis HAKAN KORKMAZ, MD Assoc. Prof. Of Otolaryngology k l k k Dışkapı Training Hospital Ankara-Turkey Bilateral vocal cord paralysis (BVCP) Iatrogenic (%50) THYROIDECTOMY** Esophageal surgery Tracheal surgery Tracheal surgery Brain stem surgery Unilateral surgery with unrecognized contralateral cord paralysis: carotid endarterectomy , completion thyroidectomy , anterior approach to servikal disk) Trauma Entubation Entubation Neurologic diseases (poliomyelitis, pseudobulbar palsy) Inflammatory (RA), metabolic (h.kalemia, h.calcemia, and toxins ( i i i l) (vincristine, taxol) Idiopathic
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Arytenoid lateralization with a simplesuture in bilateral vocal cord paralysis
THYROIDECTOMY** Esophageal surgery Tracheal surgeryTracheal surgery Brain stem surgery Unilateral surgery with unrecognized contralateral cord paralysis: carotid
endarterectomy, completion thyroidectomy, anterior approach to servikaly, p y y, ppdisk)
Patient presentation Usually 2-3 mm posterior glottic opening Usually 2-3 mm posterior glottic opening
Stridor-dyspnea
E i i t l Exersize intolerance
Usually normal voice and swallowing
INNERVATION
Superiorlaryngeal nerve
Inferiorlaryngeal nerve
Th h i d*Two 16 G iv catheters*1/0 nylon thread
The catheters are insertedtranscutaneously into thelarynxy larynx
8
The nylon thread loops around the vocalf idprocess of arytenoid
Konya, 20089
Cordotomy at 2/3 anterior and 1/3 i j iposterior junction
Konya, 200810
When the cordotomy is done, anterior2/3 of the cord becomes medialized
Konya, 200811
What determines the patients’ symptoms
Patient’s Age Gender Cardiopulmonary reserve
Position of the cords Cricothyroid muscle function Fibrosis in denervated muscles Ankylosis of cricoarytenoid joint
ff f l Stiffness of conus elasticus Muscle mass of cords
The aim of the treatment is to restore adequate airway along The aim of the treatment is to restore adequate airway alongwith preserving laryngeal functions voice production (anterior 2/3rd vocal cord should be voice production (anterior 2/3rd vocal cord should be
preserved) prevention of aspiration (avoid excessive posterior opening)p p ( p p g)
If the patient does not have compromise of daily activities; there is no need for surgical interventiong
Surgical intervention If the airway is compromised significantly immediate If the airway is compromised significantly immediate
intervention Tracheotomy X Suture lateralizationTracheotomy X Suture lateralization
If it is not emergency; timing of surgery is important If it is not emergency; timing of surgery is important It may resolve within 6-18 months Laryngeal EMG at 6 months may help Laryngeal EMG at 6 months may help Muscle atrophy worsens after 7 months
Patient evaluation History History
Physical examination Assessment of dyspnea exercise intolerance Assessment of dyspnea, exercise intolerance Telescopic office examination of larynx