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Laryngeal Abductor Paralysis

Congenital Vocal Cord Paralysis


Presentation

  • A plan of diagnosis and management is presented.[ncbi.nlm.nih.gov]
  • Table 1 Patients with multiple system atrophy who initially presented with laryngeal abductor paralysis/stridor In the cases presented, it proved true that LAP/stridor can be a solitary manifestation of MSA.[jnnp.bmj.com]
  • Despite this statement relatively few reports of congenital laryngeal-abductor paralysis can be found in the literature, and I have been unable to locate any reference to this occurrence in siblings.The present report concerns 3 brothers with congenital[nejm.org]
  • Abstract Two brothers presented with late-onset cerebellar ataxia and severe dysphonia. Brain MRI showed vermian and hemispheric cerebellar atrophy. Laringofiberscopy revealed laryngeal abductor paralysis in both patients.[neurology.org]
Physician
  • The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.[rightdiagnosis.com]
  • Although the initial presentation of LAP/stridor was not common (it occurred in only 4% of all MSA patients), it is clinically relevant because patients with LAP/stridor but without obvious neurological symptoms may see general physicians or otolaryngologists[jnnp.bmj.com]
  • Patients should address specific medical concerns with their physicians. This page was written by Scott Moses, MD, last revised on 10/21/2007 and last published on 5/8/2019.[fpnotebook.com]
  • During the history, the physician asks about all possible causes of peripheral neuropathy, including chronic heavy metal exposure (arsenic, lead, mercury), drug effects from phenytoin and vincristine, and history of connective tissue disorders, Lyme disease[merckmanuals.com]
  • TREATMENT LOCATIONS Our physicians at Houston Methodist specialize in managing voice disorders at the following convenient locations.[houstonmethodist.org]
Surgical Procedure
  • For unilateral paralysis, surgical procedures to move cords closer together For bilateral paralysis, surgical procedures and measures to maintain airway In unilateral paralysis, treatment is directed at improving voice quality through augmentation, medialization[merckmanuals.com]
  • The surgical procedure is : functional reinnervation with the upper root of one phrenic nerve, is used for reinnervation of both cricoarytenoid muscles (laryngeal inspiratory muscles), and simultaneous reinnervation of adductor laryngeal muscles is performed[clinicaltrials.gov]
  • Palabras clave: Parálisis laríngea Cirugía láser Insuficiencia respiratoria Cirugía endoscópica Láser diodo Abstract Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral vocal cord paralysis.[elsevier.es]
  • Medialization thyroplasty (MT), also known as type 1 thyroplasty, is one of the several surgical procedures that are employed for the treatment of unilateral vocal fold paralysis (UVFP).[aetna.com]
  • procedures. [5] The right RLN in particular, has a greater chance of being damaged during surgery due to its position in the neck. [5] When both of the vocal folds' PCA muscles lack a nerve supply, the term bilateral vocal fold paresis is used. [5] With[en.wikipedia.org]
Pathologist
  • This excellent guide fills a void within the field of otolaryngology and should not be missed by any otorhinolaryngologist, neurologist, phoniatrician or speech pathologist.[books.google.com]
  • Diagnosis of Spasmodic Dysphonia Our team at Houston Methodist— including otolaryngologists (ear, nose and throat, or ENT, specialists) and speech-language pathologists, as well as neurologists — will ask about your symptoms and medical history, perform[houstonmethodist.org]
  • Our speech pathologist will ensure that your child is safe from a feeding standpoint, and may recommend one of the following approaches if there is aspiration: For babies younger than 1 year, we recommend dietary modifications (such as thickening foods[chop.edu]
  • Voice assessment is necessary to plan and estimate the success of a possible speech therapy. [12] An auditory-perceptual evaluation is conducted by a Speech-Language Pathologist (S-LP), and allows changes in voice quality to be monitored over time. [14[en.wikipedia.org]
  • […] laryngoscopy - does not require general anaesthetic, so enables examination of the larynx while using the voice. [ 8 ] Stroboscopy (videolaryngostroboscopy) uses fibreoptic images in slow motion to provide pictures of the working larynx. [ 17 ] Voice pathologists[patient.info]
Disability
  • Synonyms laryngeal abductor paralysis - intellectual disability plott syndrome familial vocal cord dysfunction gerhardt syndrome Etiology Please input defination information here. Diagnosis Please input defination information here.[pediascape.org]
  • TRUE 900000000000508004 ACCEPTABILITYID 900000000000548007 900000000000490003 VALUEID 900000000000494007 6011000124106 MAPGROUP 1 6011000124106 MAPCATEGORYID 447639009 6011000124106 MAPRULE IFA 724178000 Laryngeal abductor paralysis with intellectual disability[purl.bioontology.org]
  • Vocal fold paralysis, distinguished from vocal paresis, is the total loss of vocal fold mobility due to a lack of neural input to the vocal folds. [4] These conditions result from continuous damage to the laryngeal nerves [4] [3] and often lead to vocal disability[en.wikipedia.org]
Stridor
  • In all eight patients, laryngoscopy confirmed that the stridor was caused by LAP.[jnnp.bmj.com]
  • Abstract Clinical and pathological findings are reported in three cases of Shy-Drager syndrome with laryngeal stridor severe enough to require tracheostomy.[ncbi.nlm.nih.gov]
  • .- ) tobacco use ( Z72.0 ) Diseases of the respiratory system J38 ICD-10-CM Diagnosis Code J38 Diseases of vocal cords and larynx, not elsewhere classified 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 1 Excludes congenital laryngeal stridor[icd10data.com]
  • . • Clinical features : - Dyspnoea - Stridor 21.[slideshare.net]
Respiratory Distress
  • This compromises the airways and causes respiratory distress which may often be acute necessitating tracheostomy. A lateralisation of the vocal cord is required to provide adequate airway without significantly affecting speech.[link.springer.com]
  • In incomplete bilateral abductor damage to the RLN, the adductor fibers draw the VC toward each other, and the glottis opening is reduced to a thin slit, which leads to significant respiratory distress.[otorrinos2do.wordpress.com]
  • Symptoms include respiratory distress with stridor. The situation often necessitates emergent reintubation or tracheostomy. Keyword history 75%/2014 64%/2011 Sources Atlee: Complications in Anesthesia, 2nd ed. 2006. Chapter 204.[openanesthesia.org]
  • Key words: Laryngeal paralysis Laser surgery Respiratory distress Endoscopic surgery Diode laser O texto completo está disponível em PDF Referencias [1.] D.P. Dennis, H.[elsevier.es]
  • Respiratory distress improved after tracheostomy.[neupsykey.com]
Constipation
  • In the former six patients, stridor was followed by bladder dysfunction in four, constipation in three, tremor/akinesia in one, ataxia in one, and postural hypotension in one.[jnnp.bmj.com]
Hypotension
  • In the former six patients, stridor was followed by bladder dysfunction in four, constipation in three, tremor/akinesia in one, ataxia in one, and postural hypotension in one.[jnnp.bmj.com]
  • […] paralytic patients, involves cranial nerves VII, IX, and X and the medullary reticular formation, resulting in facial weakness, difficulty swallowing, and phonation, as well as variable respiratory difficulty, ataxic breathing, lethargy, obtundation, hypotension[neupsykey.com]
Cyanosis
  • CHEVALIER Jackson, 1 in 1937, made the following comment: "Untold thousands of infants have asphyxiated because of bilateral abductor paralysis — the cyanosis being attributed to a persistent foramen ovale or failure of respiration to start."[nejm.org]
Suggestibility
  • The combined findings and the molecular analysis suggest a new familial disorder. Inheritance is most likely autosomal recessive, but X-linked transmission is also possible.[ncbi.nlm.nih.gov]
  • The interval between LAP/stridor and hospital admission was rather long (on average 5.4 years), suggesting that the progression of LAP was not very rapid in those patients.[jnnp.bmj.com]
  • The combined findings and the molecular analysis suggest a new familial disorder. Inheritance is most likely autosomal recessive, but X-linked transmission is also possible. Received December 21, 2000. Accepted February 3, 2001.[neurology.org]
  • Estimates suggest the event raised […] The Dystonia Medical Research Foundation (DMRF) could not function without dedicated, enthusiastic volunteers.[dystonia-foundation.org]
Psychomotor Retardation
  • A report on three necropsied cases, with observations on the laryngeal muscles and the nuclei ambigui. ( 7237099 ) Bannister R....Oppenheimer D.R. 1981 11 Familial laryngeal abductor paralysis and psychomotor retardation. ( 4751313 ) Watters G.V....Fitch[malacards.org]
Ataxia
  • Two brothers presented with late-onset cerebellar ataxia and severe dysphonia. Brain MRI showed vermian and hemispheric cerebellar atrophy. Laringofiberscopy revealed laryngeal abductor paralysis in both patients.[ncbi.nlm.nih.gov]
  • In the remaining two patients stridor occurred together with bladder dysfunction or gait ataxia.[jnnp.bmj.com]
  • Abstract Two brothers presented with late-onset cerebellar ataxia and severe dysphonia. Brain MRI showed vermian and hemispheric cerebellar atrophy. Laringofiberscopy revealed laryngeal abductor paralysis in both patients.[neurology.org]
  • […] manifestation. ( 17826894 ) Deguchi K....Kuriyama S. 2007 3 Laryngeal abductor paralysis can be a solitary manifestation of multiple system atrophy. ( 15946984 ) Uzawa A....Hattori T. 2005 4 Adult-onset familial laryngeal abductor paralysis, cerebellar ataxia[malacards.org]
  • & GE reflux : 3p22 HNA : SEPT9; 17q25 Recurrent laryngeal nerve lesion Vincristine Other Distal myopathy Vocal cord & Pharyngeal Δ : MATR3 Hypothyroid Myasthenia gravis Williams-Beuren syndrome Arnold-Chiari Malformation Laryngeal abductor paralysis Ataxia[neuromuscular.wustl.edu]
Tremor
  • In the former six patients, stridor was followed by bladder dysfunction in four, constipation in three, tremor/akinesia in one, ataxia in one, and postural hypotension in one.[jnnp.bmj.com]
  • Symptoms are breaks in the voice or voice tremor.[patient.info]
  • Resting tremor was absent. He showed severe dementia (MMSE 0/30). Moderate-to-severe atrophy of fronto-temporal cortex including hippocampus and ischemic change were revealed on his brain MRI (fig. 1 a).[karger.com]
  • The surgery does not treat vocal tremor. Presently there is not a satisfactory similar procedure for ABductor spasmodic dysphonia, though some have been proposed.[voicedoctor.net]
Cerebellar Ataxia
  • Two brothers presented with late-onset cerebellar ataxia and severe dysphonia. Brain MRI showed vermian and hemispheric cerebellar atrophy. Laringofiberscopy revealed laryngeal abductor paralysis in both patients.[ncbi.nlm.nih.gov]
  • Abstract Two brothers presented with late-onset cerebellar ataxia and severe dysphonia. Brain MRI showed vermian and hemispheric cerebellar atrophy. Laringofiberscopy revealed laryngeal abductor paralysis in both patients.[neurology.org]
  • ataxia, and pure motor neuropathy. ( 11376202 ) Barbieri F....De Michele G. 2001 5 Localization of the gene for familial laryngeal abductor paralysis to chromosome 6q16. ( 11493198 ) Manaligod J.M....Smith R.J. 2001 6 Syndrome of inappropriate secretion[malacards.org]
Akinesia
  • In the former six patients, stridor was followed by bladder dysfunction in four, constipation in three, tremor/akinesia in one, ataxia in one, and postural hypotension in one.[jnnp.bmj.com]
  • A neurologist of our hospital noted akinesia, mask-like face and small steppage gait and apparent dementia based on mini-mental state examination (MMSE 21/30). He was diagnosed as having probable DLB based on the clinical criteria [ 10 ].[karger.com]
Speech Disorders
  • Clinical forms and templates are included for use in assessing and treating various speech disorders.[books.google.de]
Incontinence
  • Co-morbid bladder dysfunction (particularly urinary incontinence and post-voiding residual volume of more than 100 ml), postural and postprandial syncope, parkinsonism, and ataxia are all red flags suggestive of MSA. 10 In our eight patients, bladder[jnnp.bmj.com]
Urinary Incontinence
  • Co-morbid bladder dysfunction (particularly urinary incontinence and post-voiding residual volume of more than 100 ml), postural and postprandial syncope, parkinsonism, and ataxia are all red flags suggestive of MSA. 10 In our eight patients, bladder[jnnp.bmj.com]

Workup

  • This paper addresses the established diagnostic workup for VFI and critically evaluates the contribution of different modalities to VFI diagnosis.[ejo.eg.net]
  • Although a small number of conditions account for most cases of vocal cord immobility, this article presents a comprehensive differential diagnosis, followed by the clinical presentations, diagnostic workup, and treatment options.[emedicine.medscape.com]

Treatment

  • This interactive workbook-style text highlights important concepts in the evaluation and treatment of voice and laryngeal disorders.[books.google.de]
  • Evaluation and treatment of complications of thyroid and parathyroid Surgery. Otol Clin North Am 1990;23:529.[link.springer.com]
  • Treatment Please input treatment information here. You can also add sub-section(s) at will. Labs working on this disease Please input related labs here. References Please input treatment information here.[pediascape.org]
  • Vocal Fold Paralysis is a clinically useful reference for evaluation and treatment, as well as a summary of current knowledge and investigational approaches.[books.google.com]

Prognosis

  • The position of the paralyzed VF carries no significance with respect to the site of injury or prognosis.[ejo.eg.net]
  • "Course and prognosis of myasthenia gravis: a systematic review". European Journal of Neurology. 17 (7): 913–21. doi : 10.1111/j.1468-1331.2010.03017.x. PMID 20402761. a b Shaker R (2013).[en.wikipedia.org]
  • The clinical consequences of bilateral paralysis usually depend on the position of the cords; in general, the prognosis is more serious in cases of sudden onset.[neupsykey.com]
  • To conclude, suture lateralization should be considered for all patients with BVFI, especially in cases of good prognosis for recovery. Acknowledgment We thank Dr. Madani Shahram (ENT consultant) for providing us the [Figure 4] of the ETGI.[laryngologyandvoice.org]

Etiology

  • Synonyms laryngeal abductor paralysis - intellectual disability plott syndrome familial vocal cord dysfunction gerhardt syndrome Etiology Please input defination information here. Diagnosis Please input defination information here.[pediascape.org]
  • Etiologies of the paralyses from both vocal folds are in large number, and sequelae from thyroid gland surgery predominates (3). Tumor diseases of the cervical and mediastinum areas are less common etiologies (3).[arquivosdeorl.org.br]
  • In the study by Jang et al. [80], patients with VFP of central etiology showed a higher incidence of penetration and aspiration as compared with patients with peripheral etiology.[ejo.eg.net]
  • Etiology superior thoracic masses, e.g. lung cancer (most common 7 ), aortic pathologies (e.g. thoracic aortic aneurysm ), thyroid cancer, laryngeal cancer 6,7 masses affecting the vagus nerve, e.g. jugular foramen masses, carotid body tumors surgical[radiopaedia.org]
  • Cricoarytenoid arthritis, which may cause fixation of the cricoarytenoid joint, must be differentiated from a neuromuscular etiology. Fixation is best documented by absence of passive mobility during rigid laryngoscopy under general anesthesia.[merckmanuals.com]

Epidemiology

  • Post-surgical intervention is warranted to restore laryngeal muscle strength, agility and coordination. [20] Epidemiology [ edit ] Due to the complex and controversial nature of this condition, [3] epidemiological (incidence) reports vary significantly[en.wikipedia.org]
  • Epidemiology A retrospective analysis of data from a large American claims database found that of almost 55 million individuals, 536,943 patients (ages 0 to 65 years) were given a dysphonia diagnosis (point prevalence rate of 0.98%). [ 3 ] One study screening[patient.info]
  • Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014 Jun;59(6):895–915. 14. Newman MH, Work WP. Arytenoidectomy revisited. Laryngoscope. 1976 Jun;86(6):840–9. 15. Woodman D.[e-ceo.org]
Sex distribution
Age distribution

Pathophysiology

  • Lucian Sulica, Andrew Blitzer Springer Science & Business Media, ٢٨‏/٠٤‏/٢٠٠٦ - 253 من الصفحات New therapeutic options and approaches have been developed based on an expanded knowledge of the underlying pathophysiology of vocal fold paralysis.[books.google.com]
  • 24 Pathophysiology of the Paralyzed Vocal Fold The laryngoscopic appearance of vocal fold paralysis reflects the considerable variation in the underlying pathophysiology of the condition.[entokey.com]
  • Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol. 1991;100:717-21. Hans S, Grevier-Buchanan L, Laccourreye O, Brasnu D.[revistas.usal.es]
  • Pathophysiology Although a comprehensive discussion of each of the causes is beyond the scope of this article, some principles should be emphasized.[emedicine.medscape.com]
  • Pathophysiology of vocal fold paralysis Patterns of injury The RLN contains 500-1000 motor axons, and all are myelinated [22]. The nerve trunk is a collection of fascicles.[ejo.eg.net]

Prevention

  • Transection of this nerve at the point between interarytenoid and PCA branch may prevent aberrant reinnervation of adductor nerve axons to the PCA muscle.[journals.lww.com]
  • Unilateral vocal fold paralysis can be caused by a variety of diseases or disorders that prevent movement in one vocal fold.[texasvoicecenter.com]
  • This stimulation can prevent the muscles from atrophying while they regenerate. In addition, the stimulation can re-establish reinnervation.[vanderbilthealth.com]
  • The only difference noted was that he placed three or four loops to prevent tension and cut through of the suture through the mucosa.[laryngologyandvoice.org]
  • Augmentation involves injecting a paste of plasticized particles, collagen, micronized dermis, or autologous fat into the paralyzed cord, bringing the cords closer together to improve the voice and prevent aspiration.[merckmanuals.com]

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