silicon and Vocal-Cord-Paralysis

The purpose of this study was to determine the effects of transcutaneous silicon injection on swallowing function in unilateral vocal cord paralysis with aspiration. The preoperative and postoperative swallowing function were evaluated by means of videofluoroscopy and pharyngeal manometry in eight patients who received injection of silicon into the laryngeal vestibule, ventricle and vocal cord. Data analysis compared 1) types of aspiration and pharyngeal clearance, 2) timing of laryngeal closure (complete closure between arytenoid and epiglottic base) that was correlated with the onset of cricopharyngeal (CP) opening as time zero, and 3) swallowing pressure in the pyriform sinus on the side of the paralyzed vocal cord. In seven of the 8 patients, a favorable clinical response was achieved and aspiration and/or penetration were not observed on the fluoroscopic images after the silicon injection. Timing of laryngeal closure could be quantified in six patients, and mean values of the times preceding the onset of CP opening were significantly earlier on the postoperative examinations than preoperative examinations. Pharyngeal clearance on the affected vocal cord side was improved in six of the 8 patients, and swallowing pressure in the pyriform sinus was significantly elevated in four patients following surgery. These results suggested that silicon injection therapy produced earlier laryngeal closure during the swallow and improvement of pharyngeal clearance on the affected side after the swallow, so that aspiration and/or penetration with vocal cord paralysis might be prevented.

Topics: Aged; Aged, 80 and over; Female; Humans; Injections; Male; Middle Aged; Pneumonia, Aspiration; Silicon; Vocal Cord Paralysis

Unilateral recurrent laryngeal nerve paralysis causes the vocal cord to atrophy, leading to glottic incompetence. The voice is characterized by hoarseness, breathlessness, rapid air escape, ineffective cough and aspiration. Traditional treatments of unilateral vocal cord paralysis include intracordal injection, laryngeal framework surgery, and laryngeal reinnervation for medialization of the vocal cord. In this paper we report on a new technique of transcutaneous intracordal silicon injection in which the injection is made through the thyroid lamina under local anesthesia monitoring fiberscopy. We performed this procedure on 30 patients with unilateral vocal cord paralysis and later evaluated their post-operative voice. The silicon injection resulted in improvement of vocal quality, favorable clearance of sputum, and aspiration control. We found that, since it can be performed under local anesthesia without hospitalization, transcutaneous intracordal silicon injection should be performed as a therapy for treating unilateral vocal cord paralysis.

Topics: Administration, Cutaneous; Adult; Aged; Female; Humans; Male; Middle Aged; Silicon; Vocal Cord Paralysis

Glottic closing pressure during swallowing was measured in the cat with a catheter pressure transducer to study the effectiveness of intracordal injection in increasing glottic pressure in unilateral recurrent laryngeal nerve paralysis. Swallows were elicited by pouring water into the pharynx while the animal was under light anesthesia with ketamine. Peak pressure of the glottic closure for the control group during deglutition was 68.0 +/- 10.5 mm Hg (mean +/- standard deviation). Peak pressure decreased to 22.0 +/- 3.6 mm Hg just after sectioning of the unilateral recurrent laryngeal nerve, and rose to 39.8 +/- 8.3 mm Hg by silicon injection into the paralyzed vocal fold. In a study of chronic cases 1 month or more after unilateral recurrent laryngeal nerve section, peak pressure was 49.1 +/- 23.4 mm Hg, and varied widely from 21 to 92 mm Hg because of differences in the position of the paralyzed vocal fold and the degree of compensation by the unaffected vocal fold. In the group that had the paralyzed vocal fold fixed in the median position, peak pressure was almost the same as that of the control group. When the paralyzed vocal fold was fixed in either the paramedian or lateral position, peak pressure was 33.3 +/- 7.0 mm Hg. This value was significantly elevated to 45.8 +/- 10.4 mm Hg by injection of silicon, though it remained lower than that of the control. These results suggest that the decrease in glottic closing force during swallowing as a result of unilateral recurrent laryngeal nerve lesion is compensated for by the unaffected vocal fold to some degree and is improved by intracordal injection.

Topics: Acute Disease; Animals; Cats; Chronic Disease; Deglutition; Electromyography; Glottis; Neck Muscles; Pressure; Prostheses and Implants; Recurrent Laryngeal Nerve; Silicon; Vocal Cord Paralysis; Vocal Cords

This paper presents the technique of transcutaneous intrafold silicone injection and the functional results of 44 procedures in 42 patients. The injection is given under local anesthesia with the patient in a supine position. The needle is inserted through the cricothyroid space. The location of the needle as well as the effect of injection is monitored by means of a fiberscope connected to a television camera and screen. The preoperative and postoperative vocal function was multidimensionally evaluated with the use of a test battery consisting of the maximum phonation time (MPT), mean airflow rate (MFRc), fundamental frequency (F0) range and sound pressure level (SPL) range of phonation, pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and normalized noise energy (NNEa). In the majority of the patients, MPT, F0 range, and SPL range increased and MFRc, PPQ, APQ, and NNEa decreased postoperatively. In the overall evaluation based on the test values of these parameters, the result was excellent for 16 procedures, good for 16, fair for 7, and poor for 5. The most frequent cause of failure was an insufficient amount injected.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Injections, Subcutaneous; Male; Middle Aged; Phonation; Silicon; Vocal Cord Paralysis; Voice Disorders

Topics: Esophageal Neoplasms; Humans; Pneumonia, Aspiration; Postoperative Complications; Silicon; Vocal Cord Paralysis