A Study of incidence and etiopathology of vocal cord paralysis

Vocal cord paralysis is not a disease per se but is considered as a sign of underlying disease process that may be congenital or acquired, unilateral or bilateral, sudden or gradual in onset, and may occur at any age from cradle to the grave. This study vas carried out to know the incidence and etiopathology of vocal cord paralysis.The incidence was 0.42% or 42 per ten thousand new patients seen. Most patients presented in the 5th and 6th decades (77.2%). Males outnumbered females in the ratio of 3:1. The most common symptom of vocaL cord paralysis was hoarseness of voice alone(83.6%.).Onset of symptoms was gradual in 60% of cases.Left vocal cord was almost twice more commonly (61.9%)involved than the right one(38.1%).Idiopalhic group constituted 38.18% of patients followed by neoplaslic diseases 29.09oc.     

Level of vocal folds as projected on the exterior thyroid cartilage

Objective: This study aims to identify the level of the vocal folds as projected on the exterior thyroid cartilage. Study Design: Anatomic study of human cadaver larynges. Methods: The study includes 83 fresh larynges harvested at autopsy from 62 male and 21 female cadavers. The larynges were excised and divided in the midline posteriorly. One needle was inserted at the level of anterior commissure from endolarynx, and the other was inserted at the thyroid ala just anterior to the vocal process along the superior surface of the right vocal cord. Measurements of vocal cord projections on the thyroid ala were done with a caliper. Results: The mean value of the ratio of the distances from the superior thyroid notch to anterior commissure and the midline height from thyroid notch to the inferior border of thyroid cartilage was found to be 0.41 in males and 0.38 in females. No statistical differences were observed between these two groups (P = .062). We found that the distance from the anterior commissure to the inferior thyroid border in midline “c” was longer than the distance from the posterior border of the vocal cord to the inferior border of the inferior tubercle of the thyroid ala “d” in 44 (71%) males and in 7 (33%) females. On the other hand, “d” was longer than “c” in 8 (12.9%) males and in 8 (38.1%) females. These two distances were equal in 10 (16.1%) males and in 6 (28.6%) females. Conclusion: In this study, we found that the anterior commissure lies approximately at the juncture of the upper two fifths and lower three fifths of the midline height of thyroid cartilage in the majority of the larynges of the male and female cadavers. The position of the posterior border of the vocal cords was found to be at a lower level than anterior commissure in two thirds of males and in one third of females. This means that the vocal cords slope downward posteriorly in the majority of the larynges of the males. This may be one of the causes of failure of some type I thyroplasties.     

Vocal cord nodules: a review

Vocal cord nodules have a variety of synonyms in the literature, including laryngeal nodules, laryngeal nodes, corditis nodosa, singers’ nodes, teachers’ nodules, screamers’ nodes, parsons’ nodes, and nodular laryngitis. All of these refer essentially to the same condition. In 1954 referring to vocal cord nodules, Brodnitz and Froeschels wrote that, ‘Ever since Tuerck first described the condition in 1868, discussion of the aetiology, the histological nature, and the therapy still has not ceased’. This statement still applies today.     

Preparation techniques for the injection of human autologous cartilage: an ex vivo feasibility study

OBJECTIVES: To determine the optimum donor site and preparation technique for injecting human autologous cartilage as a potentially permanent implant material for vocal fold medialization. STUDY DESIGN: Prospective ex vivo experimental model. METHODS: Human nasal septal and auricular cartilage was obtained from eight surgical cases after institutional review board approval. The auricle and nasal septum were chosen as potential donor sites because of ease of accessibility, volume of cartilage potentially available, and minimal subsequent cosmetic deformity after the tissue harvesting procedure. Various preparation techniques readily available in most operating rooms were tested for their efficacy in generating an injectable cartilage slurry. The various cartilage slurries were injected through sequentially smaller needles and examined cytologically. RESULTS: The best injection properties for both nasal septal and auricular cartilage were obtained by drilling the cartilage down with a 5 mm otologic cutting bur, which allowed free passage through an 18 gauge needle. Cytologic examination of drilled septal cartilage showed good uniformity of cartilage pieces with a mean largest dimension of 0.44 +/- 0.33 mm, and 33% of lacunae contained viable-appearing chondrocytes. Cytologic examination of drilled auricular cartilage was similar, except only 10% of lacunae were occupied by chondrocytes. Other techniques tested (knife, morselizer, and cartilage crusher) did not yield injectable cartilage slurries. CONCLUSIONS: Both nasal septal and auricular cartilage can be prepared for injection via an 18 gauge needle using a cutting otologic bur. Further testing of in vivo viability and long-term volume retention is needed.     

Fat augmentation for glottic insufficiency

OBJECTIVES: Fat lipoinjection augmentation for glottic insufficiency has been used in patients with vocal fold paralysis. Relatively little information is available on the effectiveness of fat injection in patients with vocal atrophy, intubation trauma, and post-hemilaryngectomy defects. STUDY DESIGN: This paper retrospectively compares the efficiency of fat injection in patients with vocal cord paralysis (n = 9), vocal scar (n = 13), and vocal atrophy (n = 11). METHODS: The perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after fat augmentation in 33 patients. RESULTS: Mean follow-up time was 9.7 months. Nineteen patients had excellent results. Three patients had no change. Five patients had late failure. Six patients were lost to follow-up. Phonatory function showed significant improvement in jitter, shimmer, noise-to-harmonic ratio, maximal phonation time, grade, asthenia, and breathiness (P < .05). Videolaryngostroboscopic rating showed significant improvement in right linearity of the vocal fold edge, amplitude of vocal fold vibration, excursion of the mucosal wave, vibratory behavior, and phase symmetry (P < .05). Anterior defects did better than posterior defects. Small vocal fold defects did better than large defects. CONCLUSIONS: Fat injection is a good autogenous implant and may be considered as an option in management of patients with vocal fold scar, defect, or atrophy. Reabsorption of fat is a problem, but the procedure may be repeated.     

Actinomycosis of the larynx

Actinomycosis is a rare chronic granulomatous disease that involves the upper airway and gastrointestinal tract. Approximately 40–55% of actinomycosis comprises the cervicofacial form. It presents a challenging clinical diagnostic dilemma because of variable presentations in the head and neck. Herein, we report a rare case of actinomycosis presenting as a vocal cord nodule in a healthy 21-year-old man who was not immunocompromised and had no other known medical disease.