Vocal fold paralysis

Unilateral Vocal fold paralysis (UVFP)

The vocal folds open when you inhale and close when you phonaate. In the case of UVFP, the paralysed vocal fold can not close completely. Every surgical procedure aims to move the affected vocal fold to the mid position because normally the vocal fold goes to the midposition during phonation.

Currently, the main treatment methods are:

  1. injection laryngoplasty

  2. thyroplasty type I

  3. arytenoid adduction

Although all three treatments are performed at our hospital, each has its advantages and disadvantages, as explained below.

The vocal fold open during inhalation(Lt) and close during phonation

1. Injection laryngoplasty

Some injection materials such as fat, hyaluronic acid, etc are injected into the vocal fold. This procedure is widely utilized in many institutions because of its simplicity, but the result is sometimes unsatisfactory.

Some institutions perform this procedure under general anesthesia, but because an excess or insufficiency of the injected material results in poorer voice quality. We perform this operation under topical anesthesia. Our method is a one-day office surgery, wherein the patient is awake, allows us to listen to the patient's voice during the injection. Treatment is completed within several minutes.

Given the limited improvement achievable with this method ( please see arytenoid adduction part to know the reasons) , it may not be the first choice, but it may be a good option for patients who are unwilling to be hospitalized. In addition, for patients with minor vocal cord paralysis and those who prefer to “wait and see”, this treatment is a good option.

Injectionmaterial are inject into the paralysed vocal fold

2. Thyroplasty type I

The paralyzed vocal cord is pushed to close the vocal cord using an artificial substance (Gore tex, silocone or others)

An external incision in the neck is necessary, but because the procedure is done under local anesthesia, the position of the paralyzed vocal cord can be adjusted so as to produce the best possible voice quality, which is determined by listening to the patient's voice. However, in severe cases there is a limit to voice improvement.

3. Arytenoid adduction

During vocalization, the vocal fold closes because the arytenoid cartilage adduct. The natural adduction of the affected vocal fold is fixed only through arytenoid adduction surgery. Similar to the tightening of the strings of a guitar or violin, the vocal cord needs to be tensioned to achieve optimal sound quality. Both injection laryngoplasty and type 1 thyroplasty only pushes the "loosened string" from the outside, but this is not enough to improve tension on the vocal cords.

By performing this maneuver (arytenoid adduction) and type 1 tyroplasty at the same time, almost all of our patients regained their normal voice . In other words, only this surgery can assure good voice improvement to all patients. The operation is done under local anesthesia to allow voice monitoring and it takes 2–3 hours. Furthermore, patients will have to stay in the hospital for about 7-9 days.

Arytenoid adductition is the best way to bring your voice back to normal because this procedure promotes natural vocal fold adduction