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Use of bilateral suture lateralisation technique in severe paradoxical vocal fold movement, allowing removal of long-term tracheostomy: case report

Published online by Cambridge University Press:  12 January 2012

J van Griethuysen ,
C Al Yaghchi  and
G Sandhu
J van Griethuysen*
Affiliation:
Department of ENT, Charing Cross Hospital, London, UK
C Al Yaghchi
Affiliation:
Department of ENT, Charing Cross Hospital, London, UK
G Sandhu
Affiliation:
Department of ENT, Charing Cross Hospital, London, UK
*
Address for correspondence: Dr J van Griethuysen, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK E-mail: [email protected]
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Abstract

Objective:

We report a novel bilateral suture lateralisation technique that allowed permanent tracheostomy decannulation in a patient with severe paradoxical vocal fold movement.

Case report:

A 45-year-old woman presented to the accident and emergency department with worsening shortness of breath. Flexible nasoendoscopy revealed limited vocal fold abduction and an emergency tracheostomy was sited; this was subsequently changed to a long-term Silver Negus tube. Her tracheostomy care was complicated by discomfort and dislodgement. The diagnosis of paradoxical vocal fold movement was only made when the patient presented to our department. Cognitive behaviour therapy and botulinum toxin injection were tried without success. A right vocal fold lateralisation procedure was performed, which enabled temporary tracheostomy decannulation. A left vocal fold lateralisation procedure was subsequently performed and the patient was successfully decannulated, with significant improvement in quality of life.

Conclusion:

Paradoxical vocal fold movement is a rare condition that is most commonly managed by biofeedback sessions, relaxation manoeuvres or botulinum toxin injection. However, in cases similar to ours in which these treatments are unsuccessful, we suggest a ‘last resort’ technique to manage this rare condition.

Keywords

Vocal CordTracheostomyPhonation DisordersOtorhinolaryngological Surgical Procedures
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 3 , March 2012 , pp. 328 - 330
Copyright
Copyright © JLO (1984) Limited 2012

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References

1Dunglison, R. Practice of Medicine. Philadelphia: Lee and Blanchard, 1842;257–8Google Scholar
2Leo, RJ, Konakanchi, R. Psychogenic respiratory distress: a case of paradoxical vocal cord dysfunction and literature review. Prim Care Companion J Clin Psychiatry 1999;1:39–46Google Scholar
3Kenn, K, Schmitz, M. Prevalence of vocal cord dysfunction in patients with dyspnea. First prospective clinical study. Am J Respir Crit Care Med 1997;4:155Google Scholar
4Blitzer, A, Brin, MF, Stewart, CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. Laryngoscope 1998;108:1435–41CrossRefGoogle ScholarPubMed
5Lichtenberger, G. Endo-extralaryngeal needle carrier instrument. Laryngoscope 1983;93:1348–50CrossRefGoogle ScholarPubMed
6Jóri, J, Rovó, L, Czigner, J. Vocal cord laterofixation as early treatment for acute bilateral abductor paralysis after thyroid surgery. Eur Arch Otorhinolaryngol 1998;255:375–8Google Scholar
7Mathur, NN, Kumar, S, Bothra, R. Simple method of vocal cord lateralization in bilateral abductor cord paralysis in paediatric patients. Int J Pediatr Otorhinolaryngol 2004;68:15–20Google Scholar
8Young, O, Russell, JR. Suture lateralization of vocal cord treating paradoxical vocal cord movement: a case report. Eur Arch Otorhinolaryngol 2008;265:485–7CrossRefGoogle ScholarPubMed