ENT Students Larynx Miscellaneous
5Vocal cord paralysis
Causes:
a-Intra-cranial as trauma, inflammation & tumors.
b-Cranial as trauma, inflammation (skull base osteomylitis) & tumors as Glomus.
c-Extra-cranial as trauma (surgical -thyroidectomy- & non-surgical), inflammation & tumors.
d-Idiopathic (30%).
Clinical picture:
A-Unilateral paralysis presents with hoarseness of voice & rarely aspiration.
-Examination will reveal unilateral cord paralysis which becomes shorter, thinner with arytenoids & ary-epiglottic folds leaned forward.

-The position of the paralysed vocal cord is median, para-media, cadaveric & adduction.

B-Bilateral paralysis presents with stridor mainly with or without mild hoarseness of voice.
-Examination will reveal bilateral immobile cords in the median or paramedian position.


Investigations:
-These are directed to detect the etiology as radiology (CT scan, MRI) or laboratory investigations.
Treatment:
A-Unilateral paralysis:

1-Conservative measures are the rule for 6-12 months untill compensation by the other cord takes place or spontaneous recovery is noted.
2-Vocal cord injection by fat or medialization thyroplasty can be used in cases of lateralized cord.



B-Bilateral paralysis:
1-Tracheostomy is usually needed in cases of stridor to allow spontaneous resolution within 6-12 months.
2-Widening procedures of the cords are done later as endoscopic laser cordotomy, cordectomy with or without arytenoidectomy. Lateralization thyroplasty also may be used.


10Laryngocele
Laryngocele is an air-filled cyst due to expansion of the anterior portion of the ventricle and saccule between the true and false cords. It may be congenital or acquired due to ventricular malignancy. It may be internal (within the thyroid cartilage) or external as it dissects out side the thyroid cartilage in the neck.



Clinical picture:
It presents with hoarseness, stridor and pain if infected. Examination will reveal soft, compressible mass at the lateral side of the neck which increases on coughing, while laryngoscopy will reveal smooth bulging or mass in the ventricle.
CT scan:

Treatment is by excision either endoscopically or by external approach.