Phonosurgery

5.4.1 A patient is referred from your favorite thoracic surgeon for hoarseness after aortic aneurysm repair. On exam, you find an immobile vocal fold. How can you determine the etiology?

Click to View Video

5.4.2 Vocal fold injectional medialization vs. intrachordal injection. What is the difference?

5.4.3 Unilateral vocal fold medialization by injection-what materials are available? What are the indications, advantages, and disadvantages of each?

5.4.4 While rarely used today, teflon has been used in the past for injection medializations. Discuss the formation of Teflon granulomas, their presentation, and management options.

5.4.5 Describe the different transcutaneous vs. laryngoscopic injection techniques in vocal fold medialization.

5.4.6 Discuss management options in treating glottal insufficiency from presbylaryx / vocal fold atropy and bowing.

Click to View Video

5.4.7 Discuss the management of over injection during vocal fold medialization. How is overinjection necessary, and how do you manage it when excessive? How does it differ depending on injected materials?

5.4.8 Medialization thyroplasty-what are the indications for its use, and some of the advantages and limitations.

Bielamowicz S. Perspectives on medialization laryngoplasty. Otolaryngol Clin North Am. 2004 Feb;37(1):139-60. vii. PMID:15062691

5.4.9 What are the options for medialization thyroplasty implant material?

5.4.10 What is the goal of arytenoid adduction? What clinical situations do you think Indicate a need for this procedure?

5.4.11 Would you perform an arytenoid adduction without medialization procedure?

Chester MW and MG Stewart. Arytenoid Adduction Combined with Medialization Thyroplasty: An Evidence-Based Review. Otolaryngol Head Neck Surg. 2003 Oct;129(4):305-10. PMID:14574281

5.4.12 Describe the surgical procedure of arytenoid adduction.

5.4.13 What is the success of reinnervation procedures? When is it a good option?

5.4.14 A patient is found to have bilateral vocal fold immobility in a midline position. The patient refuses tracheostomy.What issues determine your options in care? What other surgical options other than tracheostomy can you offer?

Sapundzhiev N, Lichtenberger G, Eckel HE, Friedrich G, Zenev I, Toohill RJ, Werner JA. Surgery of adult bilateral vocal fold paralysis in adduction: history and trends. Eur Arch Otorhinolaryngol. 2008 Dec;265(12):1501-1Epub 2008 Apr 17. PMID:18418622