Unilateral vocal fold paralysis

Not every patient with UVFP needs medialization

- Consider the position

- Consider a height mismatch

- approximation of the vocal processes 

Consider status - cut or unknown if cut 

Consider timing - less than a greater than 1 year 

- Most spontaneous recovery will be in the first 3 months

Consider function - if poor function at 3 months for example, intervene early 

LEMG - more helpful for predicting a poor outcome but not potential recovery 

- Better to perform later 

Case

Post viral VF paralysis 

- CT / MRI

Injection

- Saline

- Gelfoam - 4 weeks 

- Radiesee (Prolaryn) voice gel - 2-3 months 

- Cymetra - 2-3 months 

- Zyplast 3-4 months 

- Juvederm (HA gels) - 3-9 months 

- Teflon - permanent - not produced - granulomas 

- Fat - permanent - variable survival / resorption - over-inject 30% - intricate preparation to limit inflammatory response 

Inject lateral to the superior arcuate line to inject into the muscle 

- inject at the midpoint and near the vocal process (avoid anterior - constipated voice) 

Topical anesthesia 

- Start with nebulized Lidocaine 

- Drip from scope / syringe - feels like drowning 

- Transtracheal (through first tracheal ring) with 4% Lidocaine then cough 

SLN block 

Approaches

- Peroral

- Thyrohyoid - through petiole of the epiglottis, curved needle 

- Trans-cricothyrohyoid membrane approach 

- Trans-thyroid - limited by calcified thyroid cartilage, cartilage clogs the needle 

Case 

2 years UNVP after cut nerve with very lateral position

Options

- Medialization thyroplasty

- Arytenoid adduction

- Adduction arytenopexy 

- Cricothyroid subluxation