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COCLIA Laryngology: PHONOSURGERY Samuel Ostrower January 14, 2008
Recurrent Laryngeal Nerve
 
Cricoarytenoid Joint
Intrinsic Musculature
Intrinsic Musculature
1.  A patient is referred from your favorite thoracic surgeon for hoarseness after aortic aneurysm repair. On exam, you find an immobile vocal fold. How can you determine the etiology?
Patient Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Videostroboscopy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laryngeal Electromyography (EMG) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2.  Vocal fold injectional medialization Vs. Intrachordal injection.  What is the difference?
 
Medialization vs Intrachordal Injection ,[object Object],[object Object],[object Object],[object Object],[object Object]
3.  Unilateral vocal fold medialization by injection – what materials are available?  Indications and advantages?
Injection Materials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Teflon Paste (Polytef ® ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Human Micronized Dermis/AlloDerm (Cymetra ® ) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Autologous Fat ,[object Object],[object Object],[object Object],[object Object]
Bovine Collagen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cross-Linked Hyaluronic Acid Gel (Hylaform ® ) ,[object Object],[object Object],[object Object]
Calcium Hydroxyapatite Gel (Radiance FN ® ) ,[object Object],[object Object],[object Object]
4.  Discuss the management of Teflon granulomas.
Teflon Granuloma ,[object Object],[object Object],[object Object],[object Object]
Teflon Granuloma Therapeutic Options ,[object Object],[object Object],[object Object]
Lateral Laryngotomy ,[object Object],[object Object],[object Object]
5.  Describe transcutaneous vs. laryngoscopic injection in vocal fold medialization
Transcutaneous Injection Thyroplasy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transcutaneous Injection Thyroplasy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transcutaneous Injection Thyroplasy ,[object Object],[object Object],[object Object]
Laryngoscopic Injection Thyroplasty ,[object Object],[object Object],[object Object]
6.  Discuss the management of overinjection during vocal fold medialization
Overinjection ,[object Object],[object Object],[object Object]
7.  Medialization thyroplasty–indications, advantages.  Otolaryngol Head Neck Surg 1997;116:349
Type I Thyroplasty ,[object Object],[object Object],[object Object],[object Object],[object Object]
Indications ,[object Object],[object Object],[object Object],[object Object]
Timing of Surgery Otolaryngol Head Neck Surg 1997; 116:349-54
Medialization Thyroplasty Materials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Technique
Surgical Technique
Surgical Technique
Surgical Technique
Surgical Technique
9.  Goal of Arytenoid Adduction.  Indications
Arytenoid Adduction (AA) ,[object Object],[object Object],[object Object]
10.  Would you perform an arytenoid adduction without medialization procedure?  Otolaryngol Head Neck Surg 2003;129:305-310
Arytenoid adduction combined with medialization thyroplasty: an evidence-based review ( Otolaryngol Head Neck Surg 2003;129:305-310) ,[object Object],[object Object],[object Object],[object Object]
11.  How do you do an arytenoid adduction?
Arytenoid Adduction Technique
12.  What is the success of reinnervation procedures?
Reinnervation Techniques ,[object Object],[object Object]
Neuromuscular Pedicle Technique
Ansa Cervicalis-to-Recurrent Laryngeal Nerve (ansa-RLN) Anastomosis Technique
13.  Bilateral vocal fold paralysis in midline position.  Patient refuses tracheostomy.  What other surgical options can you offer?  Ann Otol Rhinol Laryngol 1991; 100:717
Bilateral Vocal Fold Paralysis - Surgical Options ,[object Object],[object Object],[object Object],[object Object],[object Object]

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