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Unilateral Vocal Fold Immobility

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Neurolaryngology

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Abstract

Immobility of the vocal folds may have different aetiologies and, consequently, may impact differently on voice function, swallowing and breathing.

Vocal fold immobility mostly occurs secondary to paralysis, paresis or palsy of the nerves innervating the larynx, tumours, scarring or pathological changes of the arycricothyroid joint and interarytenoid tissue. Additionally, functional and psychogenic reasons may coincide with vocal fold immobility. By definition, unilateral vocal fold immobility (ULVFI), as presented here, applies only to the mobility of the entire vocal fold and not to the so-called mucosal wave (phonatory immobility). The influence on the voice and the prognosis depend on the origin of the ULVFI, e.g. differences in type, fixation position and level of the possibly paralyzed vocal fold (slack or tense); the size of glottal gap; the mobility of the arytenoid cartilages; and/or the extent of tumours and scars.

In the case of a paralyzed vocal fold, symptoms can be improved by temporary augmentation (e.g. hyaluronic acid supplements) in combination with voice therapy to prevent muscle atrophy. Irreversible damage of recurrent or vagal nerve can be sufficiently compensated by phonosurgery (permanent injection laryngoplasty with polydimethylsiloxane particles as well as implantation, e.g. cartilage) in combination with voice therapy as well as with different types of thyroplasty. Less frequently applied, reinnervation of the larynx by end-to-end anastomosis, free nerve transplantation or use of neuromuscular pedicles are also published as surgical alternatives.

Office-based mobilization of luxated arytenoid cartilage, resection of tumours, surgical treatment of scars and interarytenoid mucosal bridges are further treatment options.

The success of these procedures depends on various factors, e.g. etiological and anatomical conditions, and especially on extraordinary surgical skills on the part of the surgeon.

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  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Otto-von-Guericke-University Magdeburg, Leipziger Strasse, 44, Magdeburg, Germany

    Christoph Arens & Susanne Voigt-Zimmermann

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  1. Christoph Arens
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Correspondence to Christoph Arens .

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  1. Department of Otorhinolaryngology/Head and Neck Surgery, Clinical Centre Stuttgart, Stuttgart, Germany

    Christian Sittel

  2. Department of Otorhinolaryngology and Institute of Phoniatry and Pedaudiology, Jena University Hospital, Jena, Germany

    Orlando Guntinas-Lichius

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Arens, C., Voigt-Zimmermann, S. (2018). Unilateral Vocal Fold Immobility. In: Sittel, C., Guntinas-Lichius, O. (eds) Neurolaryngology. Springer, Cham. https://doi.org/10.1007/978-3-319-61724-4_4

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