1/8. Granulomatous inflammation and nerve necrosis in a case of apparent idiopathic vocal fold paralysis: report of a case.OBJECTIVES: We will present clinical and pathologic findings of the recurrent laryngeal nerve of a 54-year-old man with apparent idiopathic vocal fold paralysis and discuss clinical and scientific implications of these findings. STUDY DESIGN: Our design is in the format of a case report with emphasis on the clinical, intraoperative, histologic, and neuropathologic findings, followed by a discussion of contemporary theories of idiopathic unilateral vocal fold immobility and the implications of our findings. methods: A 54-year-old man presented with a 2-year history of unilateral vocal fold motion impairment (VFMI) after an upper respiratory infection. Radiographic and laboratory data revealed no organic cause. The patient clinically appeared to have a classical unilateral vocal fold paralysis and had previously undergone collagen injection and medialization thyroplasty, each with only temporary improvement of voice. We performed ansa cervicalis-recurrent laryngeal nerve anastomosis. RESULTS: Intraoperative dissection revealed an indurated and thickened section of nerve approximately 15 mm in length, located at the beginning of the intralaryngeal segment, near the cricothyroid joint. Segments of this nerve were submitted for histologic evaluation, revealing necrosis with granulomatous inflammation. Postoperative electromyography and videostrobolaryngoscopy were consistent with successful reinnervation from the ansa procedure. CONCLUSIONS: The diagnosis of "idiopathic VFMI" likely represents a number of distinct pathologic entities. This case highlights our lack of understanding of idiopathic VFMI and raises many important questions regarding our current theories of this diagnosis. The clinical and pathologic implications are discussed, and continued investigation is recommended.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/8. Vocal fold paralysis and progressive cricopharyngeal stenosis reversed by cricopharyngeal myotomy.Three infants with progressive upper esophageal stenosis had bilateral vocal fold paralysis. The patients were apparently normal at birth and without neurologic abnormality. Cricopharyngeal myotomy, followed by serial dilatations, relieved esophageal stenosis and restored the swallowing function. Vocal fold mobility, to the authors' surprise, also recovered after myotomy in 2 patients. Vocal paralysis persisted in the first patient encountered, although this case was complicated by longstanding tracheostomy. Decannulation in this case was successful at 4 years only after arytenopexy and cricoid interposition grafting. Direct laryngoscopy findings showed weak abductive motion of 1 vocal fold at 14-year follow-up. Loss of vocal function secondary to constriction by a cricopharyngeal band has been previously undocumented. The potential reversibility of both vocal paralysis and esophageal stenosis by surgical cricopharyngeal myotomy is of significant clinical importance.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/8. vocal cord dysfunction presenting as bronchial asthma: the association with abnormal thoraco-abdominal wall motion.A 23 year old man with glottic dysfunction presented as recurrent bronchial asthma. His symptoms were aggravated by application of a noseclip and associated with asynchronous thoraco-abdominal wall motion. The glottic dysfunction was corrected by sedation but not continuous positive airway pressure. This is the first report of vocal cord dysfunction triggered by application of a noseclip and associated with asynchronous thoraco-abdominal wall motion.- - - - - - - - - - ranking = 6keywords = motion (Clic here for more details about this article) |
4/8. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy.Although bilateral vocal fold paralysis (BVFP) is an uncommon disorder, bilateral vocal fold motion impairment (BVFMI) resulting from a variety of laryngeal derangements is encountered with increasing frequency. Moreover, pure BVFP accounts for only a small proportion of BVFMI. When antecedent factors associated with BVFP are absent, recognition of BVFMI is often delayed and frequently overlooked. The requirements for assessment and successful management of BVFMI are 1) recognition of its presence, 2) identification of the constituent factors restricting vocal fold motion, 3) objective assessment of airway patency, and 4) selection of a reliable management plan. More often than not, two or more BVFMI-causing factors are present; only rarely is BVFMI attributable to a single vocal fold motion-limiting cause. The clinical and endoscopic examinations should evaluate the relative contributions of vocal fold paralysis, cricoarytenoid joint fixation, infiltrative disorders, and webs and synechiae that cause restricted vocal fold motion. The flow-volume loop examination documents airflow rate and volume and the site, nature, and severity of the obstructing lesion(s). This presentation describes the evaluation and rationale for management in BVFMI. The surgical techniques currently used to address BVFMI are compared to determine their respective merits and drawbacks, depending upon the constituent factors causing vocal fold motion limitation.- - - - - - - - - - ranking = 9keywords = motion (Clic here for more details about this article) |
5/8. Familial vocal cord dysfunction associated with digital anomalies.Familial vocal cord dysfunction is a rare condition that has been reported in only a few instances. This is a report of identical male twins, both of whom had congenital bilateral abductor vocal cord paresis associated with finger deformities. The vocal cord paresis progressed to paralysis that required tracheotomy, then returned to a slowly resolving paresis during which the vocal cords had uncoordinated motion generally known as synkinesis. Another male sibling and the mother had a history of stridor during infancy and finger deformities. Several other relatives had digital abnormalities, and an infant first cousin with finger abnormalities required a tracheotomy for vocal cord paralysis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/8. Cricoarytenoid arthritis and ankylosing spondylitis.A variety of systemic diseases may manifest with laryngeal symptoms. Cricoarytenoid arthritis with or without limitation of vocal fold motion is an example. It has been described in up to 25% of rheumatoid patients. Ankylosing spondylitis is classified among the seronegative spondylarthritides. Besides its systemic features, rare reports of cricoarytenoid involvement have been published. Six previous cases reported have been characterized by a long history of ankylosing spondylitis before the cricoarytenoid joint involvement occurred. We describe only the seventh case of cricoarytenoid arthritis secondary to ankylosing spondylitis and the first patient (to our knowledge) to present with bilateral vocal fold fixation as the initial presenting symptom.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/8. Laryngologic management of infants with the Chiari II syndrome.As a part of a prospective multi-disciplinary study, all children born with a Chiari II malformation within the Uppsala region during a 3-year period were evaluated for any difficulties in breathing or swallowing. The evaluation was repeated at regular intervals during their first 18 months. Direct laryngoscopies were performed using flexible fiberscopes. Four out of 22 children were found to have disturbed breathing. Among those, two suffered from central apnoeic spells as well as bilateral vocal fold motion impairment, one from apnoeic spells only and one from bilateral vocal fold motion impairment only. All four also had dysphagia with aspiration. Three of the children developed respiratory symptoms within the first 3 months and the symptoms of the fourth begun within the first 6 months. One infant with severe symptoms expired at the age of 3 months. The vocal fold paralysis, apnoeic spells and swallowing difficulties of another infant resolved following active neurosurgical management. The conclusion that laryngologic issues are prominent in the severe Chiari II syndrome was further supported by a review of four more cases managed in recent years. Laryngologic assessment in the neonatal period can help to raise the issue of early neurosurgical intervention as well as identify some of the infants who will need extensive habilitation. Screening of laryngeal function by means of flexible fiberoptic laryngoscopy is recommended.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/8. Transient vocal fold immobility.Temporary vocal fold immobility resolving in 4 weeks or less is considered a transient immobility. Many different disorders may lead to this type of laryngeal motion impairment. It is important for otolaryngologists to be familiar with the differential diagnosis for transient vocal fold immobility in order to optimize the management of these unusual cases.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |