What is a Laryngoplasty?
What is a Laryngoplasty?
Vocal cord paralysis diagnosis
How long do vocal cord injections last?
Why do vocal cords get paralyzed?
How is vocal cord surgery performed?
Liposuctioned lower abdomen fat was injected for augmentation of paralyzed vocal cord in 20 patients with UVCP. Autologous fat was harvested with an 18G needle and a 20-ml disposable syringe using a liposuction technique. Clinical follow-up after the injection was carried out from 1 to 6–21 months. Except for the physical functioning dimension of global health, voice-related subjective outcomes and acoustic variables of the patients significantly improved after surgery (P < .05). Compared with population norms, the mean (SD) scores of patients were inferior on the 36-item Short Form Health Survey dimensions of physical functioning (80.7 [22.3] vs 90.2 [17.4]) and role functioning–physical problems (65.0 [36.2] vs 80.2 [36.2]). Overall, 88.9% (24 of 27) of the patients were satisfied with their surgery. Fat injection laryngoplasty seems to be effective in enhancing acoustic and quality of life outcomes in patients with unilateral vocal cord paralysis. The effect is sustainable over 12 months.
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What is a Laryngoplasty?
Laryngoplasty, also known as Laryngeal Reconstruction, is a surgery done to rebuild the vocal cords. This procedure does not make the vocal cord move again, it helps to fix the problem with the vocal cord. Laryngoplasty helps to improve swallowing, the volume of the voice, and decrease choking. It can also help with voice fatigue (tired or worn out from talking). During the surgery, an implant is placed to push the weak or paralyzed vocal cord closer to the middle of the voice box. The implant is usually put in on one side of the voice box but could be placed on both sides. Most implants are made of silicone or a material called GOR-TEX. The implant is permanent but could be removed if needed. Another surgery must be done to remove the implant.
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Vocal cord paralysis diagnosis
Your doctor will ask about your symptoms and lifestyle, listen to your voice, and ask you how long you've had voice problems. To further evaluate your voice problems, the following tests may be performed:
- Your doctor will look at your vocal cords using a mirror or a thin, flexible tube (known as a laryngoscope or endoscope) or both. You may also have a test called videostrobolaryngoscopy that's done using a special scope that contains a tiny camera at its tip or a larger camera connected to the scope's viewing piece.
These special high-magnification endoscopes allow your doctor to view your vocal cords directly or on a video monitor to determine the movement and position of the vocal cords and whether one or both vocal cords are affected.
- Laryngeal electromyography.This test measures the electric currents in your voice box muscles. To obtain these measurements, your doctor typically inserts small needles into your vocal cord muscles through the skin of the neck.
This test doesn't usually provide information that might change the course of treatment, but it may give your doctor information about how well you may recover. This test is most useful for predicting how you'll recover when it's done between six weeks and six months after your symptoms began.
- Blood tests and scans.Because a number of diseases may cause a nerve to be injured, you may need additional tests to identify the cause of the paralysis. Tests may include blood work, X-rays, MRI or CT scans.
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How long do vocal cord injections last?
- Gelfoam
Lasts 4-6 weeks
- Radiesse Voice Gel:
Lasts 2-3 months.
- Radiesse (calcium hydroxyapatite in carboxymethylcellulose carrier
Lasts 4-6 months
The persistence of the injection likely depends on many factors including location of injection, size of needle hole (may partially extruded), recipient bed (e.g. irradiated or scarred) and other unknowns.
A single injection may occasionally last for years and may reflect either the persistence of collagen, ingrowth of new collagen, repositioning of the vocal cord by placement of the collagen, or continued reinnervation with adaptation improving glottic closure.
- Human derived collagen (Cosmoplast, Cosmoderm)
Lasts 4-6 months
- Micronized Alloderm (Cymetra)
Lasts 2-12 months
- Hyaluronic acid gels (Restylane, Perlane)
Lasts 4-6 months
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Why do vocal cords get paralyzed?
Some people are at a higher risk for vocal cord paralysis than others.
- Chest and throat surgery
People who’ve had recent surgery at or around the area of the larynx can end up with damaged vocal cords. Being intubated during any surgery can also damage your vocal cords. Thyroid, esophagus, and chest surgeries all carry some risk of damaging your vocal cords.
A small study from 2007 indicated that having intubation over the age of 50 and being intubated for more than six hours increased risk of vocal cord paralysis developing after surgery.
- Neurological conditions
Vocal cord paralysis happens because of misfiring or damaged nerves. Neurological conditions, such as Parkinson’s disease and multiple sclerosis (MS), can cause this kind of nerve damage. People with these conditions are also more likely to experience vocal cord paralysis.
Vocal cord paralysis causes
Vocal cord paralysis is usually triggered by a medical event or another health condition. These include:
- injury to chest or neck
- stroke
- tumors, either benign or malignant
- inflammation or scarring of the vocal cord joints due to strain or infection
- neurological conditions, such as MS, Parkinson’s disease, or myasthenia gravis
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How is vocal cord surgery performed?
Treatment
Treatment of vocal cord paralysis depends on the cause, the severity of symptoms and the time from the onset of symptoms. Treatment may include voice therapy, bulk injections, surgery or a combination of treatments.
In some instances, you may get better without surgical treatment. For this reason, your doctor may delay permanent surgery for at least a year from the beginning of your vocal cord paralysis.
However, surgical treatment with bulk injections containing collagen-like substances is often done within the first 3 months of voice loss.
During the waiting period for surgery, your doctor may suggest voice therapy to help keep you from using your voice improperly while the nerves heal.
Voice therapy
Voice therapy sessions involve exercises or other activities to strengthen your vocal cords, improve breath control during speech, prevent abnormal tension in other muscles around the paralyzed vocal cord or cords and protect your airway during swallowing. Occasionally, voice therapy may be the only treatment you need if your vocal cords were paralyzed in a location that doesn't require additional bulk or repositioning.
Surgery
If your vocal cord paralysis symptoms don't fully recover on their own, surgical treatments may be offered to improve your ability to speak and to swallow.
Surgical options include:
- Bulk injection. Paralysis of the nerve to your vocal cord will probably leave the vocal cord muscle thin and weak. To add bulk to a paralyzed vocal cord, a doctor who specializes in disorders of the larynx (laryngologist) may inject your vocal cord with a substance such as body fat, collagen or another approved filler substance. This added bulk brings the affected vocal cord closer to the middle of your voice box so that the opposite functioning and moving vocal cord can make closer contact with the paralyzed cord when you speak, swallow or cough.
- Structural implants. Instead of using a bulk injection, this procedure — known as thyroplasty, medialization laryngoplasty or laryngeal framework surgery — relies on the use of an implant in the larynx to reposition the vocal cord. Rarely, people who have this surgery may need to have a second surgery to reposition the implant.
- Vocal cord repositioning. In this procedure, a surgeon moves a window of your own tissue from the outside of your voice box inward, pushing the paralyzed vocal cord toward the middle of your voice box. This allows your unimpaired vocal cord to better vibrate against its paralyzed partner.
- Replacing the damaged nerve (reinnervation). In this surgery, a healthy nerve is moved from a different area of the neck to replace the damaged vocal cord. It can take as long as six to nine months before the voice improves. Some doctors combine this surgery with a bulk injection.
- Tracheotomy. If both of your vocal cords are paralyzed and positioned closely together, your airflow will be decreased. In this situation, you'll have a lot of trouble breathing and require a surgical procedure called a tracheotomy.
In a tracheotomy, an incision is made in the front of your neck and an opening created directly into the windpipe (trachea). A breathing tube is inserted, allowing air to bypass the immobilized vocal cords.
Emerging treatments
Linking the vocal cords to an alternative source of electrical stimulation — perhaps a nerve from another part of the body or a device similar to a cardiac pacemaker — may restore opening and closing of the vocal cords. Researchers continue to study this and other options.
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