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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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