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ttt of Paralysis by Injection of Vocal Cords

The most common causes of true vocal cord paralysis are lung carcinoma, surgical injury, and idiopathic causes "which will often resolve in the course of six to nine months" .
If the left true vocal cord is paralyzed, the presence of a lung carcinoma or other chest disease is likely. The left recurrent laryngeal nerve extends deep into the neck and loops around the aortic arch. It is in the chest that the lung cancer injures the nerve. The two most common surgical causes of true vocal cord paralysis are thyroid surgery, with injury to the recurrent laryngeal nerve; and carotid endarterectomy, with injury to the vagus nerve.

There are 2 basic methods of treating true vocal cord paralysis:

*Number 1: is external larynogplasty with the placement of a lateral laryngeal implant. This method was pioneered by James Netterville from Vanderbilt University in Nashville, TN. It can be done under local anesthesia, has a high success rate and is reversible. An external neck incision is required to do the procedure.

*Number 2: is injection laryngoplasty (as seen in the photo above ), which consists of of injecting the true vocal cord with gel-foam or with a variety of permanent substances. Teflon was used in the past but fell into disfavor because of tissue compatibility problems. All permanent injectable substances can be very difficult to remove if injected in the wrong place. Permanent substances include hydroxy-appetite, silicone, hyluronic acid derivatives, autologist fascia and others. One needs to be careful to match the implant with the patient. Tissue compatibility and safety are of primary concerns. Patients with a long longevity need to be injected with a well tested highly tissue compatible substance.

Gel-foam is absorbed and can be used to temporize. This method can be performed under local anesthesia, has about a 80% success rate. However it is temporary with relief lasting only for 2 to 3 months. An external incision is not required and if injected in the wrong place, it will absorb and the procedure can be repeated. The surgery is preformed with a long needle through and laryngoscope.

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