Impaired laryngeal mobility and entrapment neuropathies.

Entrapment neuropathies are rarely mentioned in phoniatrics because a definite diagnosis is very difficult to make. However, several clinical examples described here strongly support this etiology, which should now be considered in the diagnosis of both partial and complete laryngeal immobility as well as in minor neuromuscular disorders.

Temporomandibular dysfunction and dysphonia (TMD).

Freedom of the manducatory apparatus is critical to economical and accurate vocal production. Two types of dysfunction will be discussed: global muscular hypertonia of the muscular manducatory system and dysfunction of the temporomandibular joint (TMJ). Hypertonia occurs in a high number of dysphonic patients. It impairs mandibular mobility and also induces chronic hypertonia of the tongue muscles, hyoid apparatus and occipitocervical joint through the neuromuscular facilitation process. TMJ can be a major source of mandibular kinetics impairment. Its pathogenic effects are most deeply felt in singers, who often have their mouths wide open, especially when singing notes in the upper register. Affected singers generally use an avoidance or compensation strategy which is detrimental to optimal use of resonance cavities and vocal sound articulation. It is consequently vital to understand TMJ pathophysiology and to include an examination of the manducatory apparatus in any clinical evaluation of dysphonia.

[Human skull development and voice disorders]. / De l'hominisation du crâne à la dysphonie fonctionnelle.

The hominisation of the skull comes with the bipedic posture, due to a network of muscular and aponevrotic forces applied to the cranio-facial skeleton. A brief sight of the morphogenetic origine and issues of these forces help to understand more clearly the postural statement of the larynx, his functions, and his many extrinsic biomechanical bounds; then further his most frequently dysfunctions. The larynx is surrounded by several effective systems of protection: active, activo-passive, passive. The architectural features of the components of the laryngeal system allows us to consider the laryngeal function as an auto-balanced system. All the forces engaged are auto-balanced in a continuum of tension. This lead us to the concept of tensegrity system, neologism coming from tensional integrity described by Buckminster Fuller. The laryngeal employement by extrinsic system is pathological in case of chronicity. Any osteopathic treatment, which aims to restore the losses of laryngeal mobility, has to release first the peripherical structures involved in the laryngeal defense, before normalising the larynx itself Finally, the larynx recovers his functions in a tensegrity system.

[Manual care in speech rehabilitation]. / Les gestes de thérapie manuelle en reeducation de la voix.

The speech therapists work on voice rehabilitation, with different kinds of formation. The dysfunctions of the vocal gesture may have various causes, and manual therapy is some time usefull to correct them. A study shows that using manual therapy is already effective after 10 voice sessions.

[Contribution of electroglottography to laryngeal motion disorders]. / Apport de l'électroglottographie aux troubles de la mobilité laryngée.

Electroglottography allows a precise observation of the vocal folds behavior in phonation of laryngeal motion deficiencies; the therapy can be improved by compared evaluation of the vocal fold contact area.

[The phoniatrician and the actor]. / Le phoniatre et le comédien.

Each vocal gesture creates each different vocal style. The voice therapist helps the comedian to find all his vocal styles and teaches him how to switch from one to another quickly, while maintaining the integrity of each vocal configuration.

[Modes of appearance of vocal cord polyps]. / Mode d'apparition des polypes des cordes vocales.

A certain number of polyps of the vocal folds result from violent, intense and unaccustomed physical activity. The development of these polyps is certainly linked to high subglottal pressure and the abrupt reduction of the same.

Epidermoid cysts, sulci, and mucosal bridges of the true vocal cord: a report of 157 cases.

Presented is a summary of our experience with 157 patients having a diagnosis of epidermoid cyst, glottic sulcus, or mucosal bridge of the true vocal cord. Each patient in this group was diagnosed and treated jointly by a phoniatrist and microlaryngoscopist and then evaluated for results of surgical and phoniatric therapy. Included in the discussion are methods of examination and diagnosis, microanatomy and histopathology of the lesions, methods of treatment, and results of treatment. An argument for a common etiology for these lesions is advanced.

Epidermoid cysts of the vocal cords.

Fifty-three cases of intracordal epidermoid cysts diagnosed, treated and followed from 1972 to 1981 are presented. In the clinical evaluation, special attention must be paid to the type of dysphonia and morphology of the vocal cords at indirect laryngoscopy. The epidermoid cyst is not easily visualized and the examiner must take into account signs like "monochorditis," slight bulging, unilateral nodule and diminished or abolished vibrations of one of the cords at stroboscopy. Microsurgical excision followed by voice therapy is the recommended treatment. The pathogenesis of these cysts is still speculative. Two theories are discussed: the traumatic theory and the dysembryoplastic theory.

Diagnosis and treatment of intracordal cysts.

Seventy-one cases of intracordal cysts are reported. They were all diagnosed between 1970 and 1980: 53 were epidermoid and 18 retention cysts. They caused longstanding dysphonia characterized by lowered tonality, huskiness, desonorization, and vocal strain. Clinical signs were often discrete and stroboscopy revealed a lack of vibrations on the cystic cord. Surgery was followed by vocal re-education and there was a high percentage of good vocal results.