Unilateral Vocal Cord Paralysis In Gastrointestinal Malignancies- A Rare Presentation

Background Advancements in diagnostic modalities have brought many hidden etiological causes of unilateral vocal cord paralysis (UVCP) to light. Here we are presenting two cases of gastrointestinal (GI) malignancies with metastases causing UVCP which can further add to another rare cause of UVCP. Case summary We are presenting a case of 40 year male with metastatic periampullary carcinoma leading to UVCP and another case of 45 year female with rectal carcinoma further causing UVCP. Both patients were under treatment while during follow-up, symptoms of UVCP were observed which changed our perspective towards cases of UVCP. Conclusion Vocal cord palsy is a symptom of an underlying disorder and not a disease. In above case reports metastases are the commonest etiology for vocal cord palsy. Relevant investigations have to be conducted in order to diagnose the etiology and the modality of treatment varies depending on the etiology of the condition.

Benefits of Palliative Office-Based Hyaluronic Acid Injection Laryngoplasty in Cancer-Related Unilateral Vocal Cord Paralysis Patients

BACKGROUND AND OBJECTIVES: The effect of palliative injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients on voice and swallowing function is uncertain and there are few previous studies of its suitability, benefits as a palliative treatment option. The purpose of this study is to confirm the objective results of voice and swallowing function after palliative office-based hyaluronic acid injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients. MATERIALS AND METHOD: 36 patients who had unilateral vocal cord paralysis from non-thyroidal, extralaryngeal neoplasms were included in this study. To evaluate the clinical outcome, we analyzed perceptual GRBAS grading, acoustic analysis, aerodynamic study, Electroglottography (EGG), Voice Handicap Index (VHI-30) about voice function and disability rating scale (DRS), gastric tube dependency, aspiration pneumonia about swallowing function and 36-Item Short Form Survey version 2 (SF-36v2) about quality of life. RESULTS: In GRBAS scale, G (p < 0.001), R (p=0.004), B (p=0.001), A (p=0.011), and S (p=0.007) showed significant improvement. Jitter, shimmer, speaking fundamental frequency, maximal phonation time, VHI-30, DRS score, gastric tube dependency, aspiration pneumonia, and SF-36v2 were significantly improved after injection (p=0.016, p=0.011, p=0.045, p=0.005, p < 0.001, p < 0.001 p=0.003, p < 0.001, and p < 0.001 respectively). CONCLUSION: From this study we concluded office-based hyaluronic acid injection can be used as a useful palliative treatment option in cancer-related ill patients with unilateral vocal cord paralysis. Palliative hyaluronic acid injection laryngoplasty avoids the need for tube feeding, thus reducing the risk of aspiration pneumonia. These outcomes are accompanied by significant improvement in voice quality.

Medialization thyroplasty using a pocket and silicone implant technique

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> To describe a new method of medialization thyroplasty using a modified preformed nasal silicone implant.<br /><strong>METHODS:</strong> <br /><strong>Design:</strong> Surgical Innovation<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Participants:</strong> Four patients underwent medialization thyroplasty using a pocket and nasal implant technique performed by the senior co-author. The indication for medialization thyroplasty for these patients was hoarseness secondary to unilateral vocal fold paralysis of more than 6 months duration, and documented by flexible fiberoptic laryngoscopy. The outcomes were described with comparison of pre- and post-operative subjective voice assessment. <br /><strong>RESULTS:</strong> Operative time was 15-30 minutes. Postoperative subjective improvement of voice quality was evident. Scars were minimal and aesthetically acceptable. The procedure could be done on an outpatient basis.<br /><strong>CONCLUSION:</strong> Medialization thyroplasty via a pocket and silicone implant technique is initially effective and may be a worthwhile alternative to the usual window technique.</p>

Telelaryngoscopic Findings in the Unilateral Vocal Fold Paralysis with Diplophonia / 대한이비인후과학회지

OBJECTIVES: Diplophonia is the voice of two separate tones through quasi-periodic variations in the vocal cord vibration when an imbalance in the tension and the level applied to the vocal cords. The purpose of this study is to investigate the relationship between the occurrence of the diplophonia and the endoscopic findings in the unilateral vocal cord paralysis. MATERIALS AND METHOD: A retrospective review was employed using video recorded images of larynx with unilateral vocal cord paralysis. A total 104 patients selected for this study complained of voice change due to unilaterally paralyzed vocal cord. Video-recordings were obtained using a laryngeal telescope. The paralyzed positions, bowing, shapes of the paralyzed arytenoids and level differences between two vocal folds were evaluated according to whether diplophonia. existed or not. RESULTS: A large number of patients of paramedian paralysis showed diplophonia when the bowing of paralyzed vocal fold was shown. However, diplophonia was shown in a small number of patients with median and intermediate paralysis. Diplophonia also seems to occur when the vertical mismatch was shown. CONCLUSION: Occurene of diplophonia depends largely on the paralyzed position, adequate glottal gap such as paramedian position, with the presence of bowing of paralyzed vocal cord.

Treatment of unilateral vocal cord paralysis by submucous infection of fat

Fat submucous injection into the vocal cord for treating unilateral vocal cord paralysis is a simple and effective technique. It can restore vocal cord function. This technique can be performed easily with the conventional modified instruments

Unilateral Vocal Cord Paralysis Following Tracheal Extubation: A case report / 대한마취과학회지

We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time.