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The essential goal of injection laryngoplasty is to implant a substance that can fill space and restore characteristics of the vocal fold favoring oscillation without inducing adverse tissue reaction. To this end, it is desirable to use a substance with characteristics of vocal fold lamina propria. The evolution of injection laryngoplasty began with a simple goal of filling space to achieve glottic competence with an inert substance that could be easily injected. Later clinical interest was...

References

Zaretsky L, Sanders I (1992) The three bellies of the canine cricothyroid muscle. Ann Otol Rhinol Laryngol (Suppl) 156 3-16 2. Sanders I, Jacobs I, Wu, Biller HF (1993) The three bellies of the canine posterior cricoarytenoid muscle implications for understanding laryngeal function. Laryngoscope 103 171-177 3. Sanders I, Bei-Lian W, Liancai M, Biller HF (1994) The innervation of the human posterior cricoarytenoid muscle evidence for at least two neuromuscular compartments. Laryngoscope 104...

Vocal Fold Augmentation with Calcium Hydroxylapatite

Postma Synthetic calcium hydroxylapatite (CaHA Radiesse, BioForm, Franksville, Wis.) was approved for vocal fold augmentation by the United States Food and Drug Administration (FDA) Center for Devices and Radiological Health in January 2002. Calcium hydroxylapatite is the primary mineral constituent of bone and teeth. The substance has a proven track record of being highly biocompatible 1-6 . The laryngeal implant is created by suspending CaHA spherules in a gel...

Superior Arcuate Line Vocal Fold

Vocal fold injection for global augmentation of the vocal fold is a successful way to treat glottal closure insufficiency 1 . Autologous fat is an excellent material for this type of vocal fold injection. This chapter discusses the patient selection, clinical aspects, and post-operative management issues related to vocal fold lipoin-jection. RationaleforVocal Fold Lipoinjection The distinct advantage of vocal fold lipoinjection is the use of an autologous material that is usually readily...

Uv

Many motor units firing slowly indicating concern for a central deficit. Note that the recruitment pattern is not as full as in Fig. 5.5, and that the motor units do not seem to be rapidly repetitive as in Fig. 5.5. This condition is characterized as many motor units firing slowly. 2. A severe peripheral nerve injury with a few motor units, usually firing fast 3. A moderate peripheral nerve injury with many motor units but decreased recruitment These four groups can further be...

Subglottic Jet Ventilation

Each package ofRadiesse contains 1 cc of implant in a Luer-Lok syringe Radiesse can be injected percutaneously either through the cricothyroid membrane or directly through the thyroid cartilage under transnasal fiberoptic laryngoscopy (TFL) guidance. The CaHA can also be injected in the office setting per-orally through a curved laryngeal needle. Anesthesia can be achieved with a combination of superior laryngeal nerve blocks and an instillation of 2 cc of 1 lidocaine into the...

Anterior

The appropriate-size window caliper is used to measure from inferior border of thyroid cartilage, anterior and posterior to inferior thyroid tubercle, to superior border of thyroplasty window. A line is extended anteriorly through these points. The key point is then measured with the same caliper from anterior midline of thyroid cartilage, marking the anterior-superior angle of thyro-plastywindow. (From 2 ) (Fig. 9.2.2) and is carefully elevated form the...

Success Rate Of Gore Tex Thyroplasty

Thyroplasty

Surgical correction of arytenoid position is an effective means of managing patients with posterior glottic incompetence due to laryngeal paralysis 1-3 . Many surgeons avoid arytenoid procedures because they perceive this approach to be difficult and fraught with complications 4 . Additionally, most patients with laryngeal paralysis respond to either injection augmentation or open thyroplasty however, persisting posterior gap is a common reason for failure of medialization procedures. A review...

Conventional Treatment for Laryngeal Paralysis

Decisions regarding intervention in cases of vocal fold paralysis are made on the basis of the laryngeal function that is most compromised. In the case of unilateral paralysis, the voice is breathy and the patient is at risk for aspiration due to compromised adduction. Inspiratory capacity is minimally impaired, as abduction of the opposite vocal fold provides adequate ventilation. In bilateral paralysis, the gravest concern is total loss of abduction. Because the vocal folds are paralyzed in...

RLN Branching Patterns

Inferior laryngeal nerve crosses posterior to the common carotid artery and enters the larynx posterior to the CT joint 13 . This aberrant pathway is explained by abnormal embryo-logical development. Normally, the recurrent laryngeal nerves are pulled caudad in the neck and chest around the sixth arches of the aorta. The left sixth arch remains as the ductus arteriosus, and later the ligamentum arteriosum. The right sixth arch normally resorbs, allowing the right RLN to pass inferior to the...

Medialization Laryngoplasty with Gore Tex Expanded Polytetrafluoroethylene

Hoffman Although the ideal implant material for medialization laryngoplasty has not been defined, there has been increased enthusiasm for the utilization of expanded polytetrafluoroethylene or Gore-Tex as the implant of choice in the treatment of unilateral vocal cord paralysis. This material has many advantages not found in solid implant types however, there is more to Gore-Tex medialization laryngoplasty than simply an alternative implant material. The technique...

Kurz Titanium Thyroplasty Prosthesis

Vocal Cord Medialization

Titanium Ti, anatomic number 22 was a laboratory rarity until William Kroll 1889-1973 developed a process for commercial production of titanium alloys by combining titanium tetrachloride with calcium to produce ductile titanium the Kroll Process . Titanium is the fourth most abundant structural metal on Earth. Today, it is widely used in medical devices, dental applications, and surgical implants due to its superior biological performance. About as strong as steel, titanium is 50 lighter. Its...

Innervation and Functional Anatomy of Laryngeal Muscles

Laryngeal Muscles

As a matter of basic orientation, a conventional view of laryngeal anatomy is briefly presented. The intrinsic laryngeal muscles have both their origin and insertion on the cricoid, thyroid, or arytenoid cartilage. In concert, they orchestrate the motion of the vocal folds during respiration, vocalization, and airway protection. The paired posterior cricoarytenoid PCA muscles are situated on the posterior larynx Fig. 2.1A . When the PCA contracts, it rocks the arytenoid cartilage in a...

Treatment ofGlottal Insufficiency Using Hyaluronan

Hyaluronan Chemical

Stellan Herteg rd, ke Dahlqvist, Lars Hall n, Claude Laurent The main things to be understood about hyaluronan are as follows Hyaluronan hyaluronic acid, HA is a linear polysaccharide ubiquitous in all mammals which is naturally present in tissues, including the vocal folds. Hyaluronan is non-toxic, non-antigenic, non-inflammatory and is involved in many biological actions, such as wound healing and anti-adhesion. Hyaluronan binds water, regulates tissue osmosis and exerts viscoelasticity....

Consequence of RLN Injury

Rat Larynx

Acute temporary laryngeal paralysis known as neurapraxia may be more common than indicated by patient numbers, as it resolves quickly within days or weeks. The paralysis stems from loss of signal conduction due to demyeliniza-tion without disruption of axons. Full recovery follows remyelinization by Schwann cells. Rehabilitation may take longer in case of axo-notmesis e.g., nerve crush , where the injury is severe enough to anatomically disrupt axons. Recovery ensues because regenerating axons...

The VoCoM Vocal Cord Medialization System

Medialization Thyroplasty

The VoCoM thyroplasty method 1 is a self-contained system of implants and instruments to allow accurate vocal fold medialization. The VoCoM system can provide membranous vocal fold medialization in addition to moderate medialization of the vocal process of the arytenoid. The implants come in five sizes, and are secured with one of four shims allowing placement of the implant in several different positions. Specifically, the implant can be secured in a horizontal or vertical orientation, with...

Relationship of RLN with Inferior Thyroid Artery

The recurrent laryngeal nerve's intimate course with the inferior thyroid artery has long been the subject of anatomists endeavors in an effort to simplify the surgical approach and technique. Unfortunately, the course of the RLN as it relates to the inferior thyroid artery does not lend itself to broad and safe generalizations. Historically, the left RLN is described coursing deep to the inferior thyroid artery ITA in the majority of cases, and the right RLN passing deep to, superficial to, or...

Medialization Thyroplasty Using the Montgomery Thyroplasty System

Brandsted The Montgomery Thyroplasty Implant System was developed in order to simplify the implant technique while providing both anterior and posterior vocal cord medialization 1,2 . Its design advantages include A readily available implant in varying sizes, thus bypassing the necessity to fashion or alter the implant material Specially designed measuring tools to facilitate localization of the thyroid window The use of an implant measuring device, so that the...