Intraoperative Laryngeal Electromyographic Assessment of Patients with Immobile Vocal Fold

1992 ◽  
Vol 101 (10) ◽  
pp. 799-806 ◽  
Author(s):  
Peak Woo ◽  
Hernando Arandia
Keyword(s):  
Vocal Fold ◽  
Muscle Relaxation ◽  
Motor Units ◽  
Vocal Folds ◽  
Electrode Position ◽  
Recurrent Nerve ◽  
Laryngeal Paralysis ◽  
Vocal Fold Immobility ◽  
Hook Wire ◽  
Thyroarytenoid Muscle

The differential diagnosis of laryngeal ankylosis versus paralysis is occasionally difficult in patients with immobile vocal folds. Eight patients with acute and chronic evidence of vocal fold immobility were investigated by intraoperative electromyography (IEMG) during planned microlaryngoscopy. Bipolar hook wire electrodes were inserted into the thyroarytenoid muscle, of which the electrical activity was monitored during neuromotor blockade and emergence from anesthesia. The normal side and the side with ankylosis or stenosis showed normal IEMG activity. There was progressive recruitment of larger motor units during recovery from muscle relaxation. Patients with laryngeal paralysis failed to show such recruitment patterns. Thus, IEMG can be used as a diagnostic tool during operative laryngoscopy to differentiate neuromotor injury from anatomic causes of vocal fold immobility. The advantages of IEMG are its ease of application and certainty of electrode position. It can also be used to monitor recurrent nerve integrity and detect early laryngospasm. Further IEMG clinical study is warranted.

Value of Laryngeal Electromyography in Diagnosis of Vocal Fold Immobility

2007 ◽  
Vol 116 (8) ◽  
pp. 576-581 ◽  
Author(s):  
Wen Xu ◽  
Demin Han ◽  
Lizhen Hou ◽  
Li Zhang ◽  
Gongwei Zhao
Keyword(s):  
Vocal Fold ◽  
Motor Unit Potential ◽  
Laryngeal Electromyography ◽  
Potential Measurement ◽  
Laryngeal Paralysis ◽  
Posterior Cricoarytenoid Muscle ◽  
Lower Amplitude ◽  
Vocal Fold Immobility ◽  
Posterior Cricoarytenoid ◽  
Thyroarytenoid Muscle

Objectives: We sought to determine the value of laryngeal electromyography (LEMG) and evoked LEMG in the diagnosis of vocal fold immobility. Methods: We analyzed 110 cases of vocal fold immobility by their clinical manifestations and LEMG characteristics, including spontaneous potential activity, motor unit potential measurement, recruitment pattern analysis, and evoked LEMG signals. Results: With LEMG, we identified 87 patients with neuropathic laryngeal injuries. Neurogenic vocal fold immobility showed a wide variety of abnormal activity. Fibrillation potentials and positive sharp waves were found in patients with laryngeal nerve injuries. For laryngeal paralysis, there was no reaction with LEMG and evoked LEMG. For incomplete laryngeal paralysis, decreased evoked LEMG signals were also seen with delayed latency (thyroarytenoid muscle, 2.2 ± 1.0 ms, p < 01; posterior cricoarytenoid muscle, 2.4 ± 1.0 ms, p < .05) and lower amplitude (thyroarytenoid muscle, 0.9 ± 0.7 mV, p < .05; posterior cricoarytenoid muscle, 1.2 ± 1.0 mV, p < .01). Nineteen patients with vocal fold mechanical limitations generally had normal LEMG and evoked LEMG signals. Four patients with neoplastic infiltration of the laryngeal muscles demonstrated abnormal LEMG signals but nearly normal evoked LEMG signals. Conclusions: We conclude that LEMG and evoked LEMG behavior plays a crucial role in the diagnosis of vocal fold immobility. The decreased recruitment activities on LEMG and the decreased evoked LEMG signals with longer latency and lower amplitude reflect the severity of neuropathic laryngeal injury.

Thyroarytenoid Muscle Maintains Normal Contractile Force in Chronic Vocal Fold Immobility

2001 ◽  
Vol 111 (12) ◽  
pp. 2152-2156 ◽  
Author(s):  
Michael M. Johns ◽  
Melanie Urbanchek ◽  
Douglas B. Chepeha ◽  
William M. Kuzon ◽  
Norman D. Hogikyan
Keyword(s):  
Vocal Fold ◽  
Contractile Force ◽  
Vocal Fold Immobility ◽  
Thyroarytenoid Muscle

Contractile Properties of Canine Thyroarytenoid Muscle Reinnervated from the Ansa Cervicalis

1989 ◽  
Vol 98 (2) ◽  
pp. 153-156 ◽  
Author(s):  
Dale H. Rice ◽  
Donald S. Cooper
Keyword(s):  
Vocal Fold ◽  
Isometric Force ◽  
Thyroid Cartilage ◽  
Force Transducer ◽  
Contractile Properties ◽  
Distal Stump ◽  
Recurrent Nerve ◽  
Ansa Cervicalis ◽  
Thyroarytenoid Muscle ◽  
Indirect Stimulation

In an attempt to obtain data on the contractile properties of vocal fold muscle reinnervated from the ansa cervicalis, we severed the recurrent nerve and connected its distal stump to the ansa cervicalis by an end-to-end anastomosis in a series of dogs. Each dog was allowed to heal for 5 months. Then the section of the thyroid cartilage on which the vocal fold muscle inserted was detached, connected to an isometric force transducer, and activated by indirect stimulation successively on both the operated and unoperated sides. A series of twitch contractions was recorded from each side. In two dogs no contractile response was obtained. In the three others, the twitch contraction time was increased significantly, by 23% to 60%. In two of three dogs, the operated muscle was significantly weaker than the unoperated muscle. The reinnervated thyroarytenoid muscle changed its speed in the direction of the donor sternothyroid muscle.

Human Vocalis Contains Distinct Superior and Inferior Subcompartments: Possible Candidates for the Two Masses of Vocal Fold Vibration

1998 ◽  
Vol 107 (10) ◽  
pp. 826-833 ◽  
Author(s):  
Ira Sanders ◽  
Yingshi Han ◽  
Surinder Rai ◽  
Hugh F. Biller
Keyword(s):  
Vocal Fold ◽  
Muscle Fibers ◽  
Vocal Folds ◽  
Medial Surface ◽  
Vocal Fold Vibration ◽  
Muscle Fascicle ◽  
Superior Surface ◽  
Hematoxylin And Eosin ◽  
Thyroarytenoid Muscle ◽  
Large Muscle

It is not understood how different parts of the thyroarytenoid muscle contribute to vocal fold vibration. This study investigated the medial part of the thyroarytenoid muscle, the vocalis compartment, for anatomic differences that might suggest functionally distinct areas. Twenty human vocal folds were frontally sectioned and stained with hematoxylin and eosin. A single section from the middle of each vocal fold was magnified, and the muscle fascicles of the most superficial 25% of the vocalis compartment were then examined. In all 20 specimens the vocalis compartment could be separated into 2 plainly distinct subcompartments: the inferior vocalis compartment was composed of a single large muscle fascicle that contained densely packed muscle fibers of similar size; the superior vocalis compartment was composed of multiple small fascicles in which the muscle fibers were loosely arranged and varied greatly in size. On average, the inferior vocalis subcompartment composed 60% of the medial surface of the thyroarytenoid muscle. The superior subcompartment composed the remaining 40% of the medial surface, but also continued past the vocal ligament to make up the superior surface of the thyroarytenoid muscle. It is concluded that 2 distinct entities make up the vocalis compartment of the thyroarytenoid muscle. Their anatomy is so markedly different it suggests that they may function independently. One possibility is that they reflect the 2 masses observed in the superior and inferior aspects of the vocal fold during vibration.

scholarly journals Asymmetry of the Vocal Folds in Patients With Vocal Fold Immobility

2005 ◽  
Vol 131 (5) ◽  
pp. 399 ◽  
Author(s):  
Yukio Oyamada ◽  
Eiji Yumoto ◽  
Koji Nakano ◽  
Hidenori Goto
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Immobility

Function of the Thyroarytenoid Muscle in a Canine Laryngeal Model

1993 ◽  
Vol 102 (10) ◽  
pp. 769-776 ◽  
Author(s):  
Hong-Shik Choi ◽  
Ming Ye ◽  
Gerald S. Berke ◽  
Jody Kreiman
Keyword(s):  
Muscle Activity ◽  
High Frequency ◽  
Vocal Fold ◽  
Muscle Activation ◽  
Thyroid Cartilage ◽  
Vocal Folds ◽  
Vocal Fold Vibration ◽  
Thyroarytenoid Muscle

Fundamental frequency is controlled by contraction of the thyroarytenoid (TA) and cricothyroid (CT) muscles. While activity of the CT muscle is known to tense and thin the vocal folds, little is known about the effect of the TA muscle on vocal fold vibration. An in vivo canine laryngeal model was used to examine the role of the TA muscle in controlling phonation. Isolated TA muscle activation was obtained by stimulating sectioned terminal TA branches through small thyroid cartilage windows. Subglottic pressure measures, electroglottographic and photoglottographic signals, and acoustic signals were obtained in 5 mongrel dogs during dynamic and static variations in TA muscle activity. Results indicated that TA muscle activation is a major determinant in sudden shifts from high-frequency to modal phonation. Subglottic pressure increased and open quotient decreased gradually with increasing TA activation.

Intra-Operative Laryngoscopic Instrument for Characterizing Vocal Fold Viscoelasticity

2007 ◽  
Author(s):  
Mark P. Ottensmeyer ◽  
Michael Yip ◽  
Conor J. Walsh ◽  
James B. Kobler ◽  
James T. Heaton ◽  
...  
Keyword(s):  
Epithelial Cells ◽  
Lamina Propria ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Aging Process ◽  
Thick Layer ◽  
Vocal Folds ◽  
Natural Form ◽  
Vibrating Structures ◽  
Thyroarytenoid Muscle

Our society depends on communication, the most natural form of which is speech. Trauma, disease and the normal aging process will cause many to suffer degraded or lost vocal fold function, and it has been observed that this number is growing [1]. The vocal folds are the vibrating structures in the larynx that enable us to generate voice, from speech to opera singing. The vibrating portions of the folds consist of an external 0.1mm thick layer of epithelial cells, a soft, gel-like 0.5mm thick layer called the lamina propria (LP), a 0.3mm thick vocal ligament and an underlying thyroarytenoid muscle [2]. The fundamental frequency of speech in men is in the 100–150Hz range, and between 200 and 300Hz in women [3].

Viscoelastic Properties of Rabbit Vocal Folds after Augmentation

2003 ◽  
Vol 128 (3) ◽  
pp. 401-406 ◽  
Author(s):  
Stellan Hertegård ◽  
Åke Dahlqvist ◽  
Claude Laurent ◽  
Assunta Borzacchiello ◽  
Luigi Ambrosio
Keyword(s):  
Dynamic Viscosity ◽  
Viscoelastic Properties ◽  
Small Amplitude ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Short Term ◽  
Glottal Insufficiency ◽  
Thyroarytenoid Muscle ◽  
Small Amplitude Oscillation

BACKGROUND: Vocal fold function is closely related to tissue viscoelasticity. Augmentation substances may alter the viscoelastic properties of vocal fold tissues and hence their vibratory capacity. OBJECTIVES: We sought to investigate the viscoelastic properties of rabbit vocal folds in vitro after injections of various augmentation substances. STUDY DESIGN AND SETTING: Polytetrafluoroethylene (Teflon), cross-linked collagen (Zyplast), and cross-linked hyaluronan, hylan b gel (Hylaform) were injected into the lamina propria and the thyroarytenoid muscle of rabbit vocal folds. Dynamic viscosity of the injected vocal fold as a function of frequency was measured with a Bohlin parallelplate rheometer during small-amplitude oscillation. RESULTS: All injected vocal folds showed a decreasing dynamic viscosity with increasing frequency. Vocal fold samples injected with hylan b gel showed the lowest dynamic viscosity, quite close to noninjected control samples. Vocal folds injected with polytetrafluoroethylene showed the highest dynamic viscosity followed by the collagen samples. CONCLUSIONS: The data indicated that hylan b gel in short-term renders the most natural viscoelastic properties to the vocal fold among the substances tested. This is of importance to restore/preserve the vibratory capacity of the vocal folds when glottal insufficiency is treated with injections.

Endoscopic radiosurgical posterior transverse cordotomy for bilateral median vocal fold immobility

2004 ◽  
Vol 118 (3) ◽  
pp. 202-206 ◽  
Author(s):  
Sayed Elsherief ◽  
Mohamed Nasser Elsheikh
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Voice Quality ◽  
Vocal Folds ◽  
Management Approach ◽  
Significant Difference ◽  
One Step ◽  
Vocal Fold Immobility ◽  
Bilateral Vocal Fold Immobility

The objectives in treatment of bilateral vocal fold immobility (BVFI) are to achieve adequate airway, preservation of voice quality and laryngeal competence. The present prospective study was designed to evaluate precisely the efficiency and long-term clinical outcome in a series of 13 patients with irreversible BVFI, consecutively managed with endoscopic radiosurgical posterior transverse cordotomy (ERPTC). The operation was performed endoscopically using an Ellman Radiosurgical Instrument and a specially designed electrode. Pre- and post-operative inspiratory function measurements and acoustical vocal analysis were conducted on the patients and were tested for potential statistical relation to successful rehabilitation of the airway. One-step, successful restoration of the airway was achieved in all patients. The post-operative improvement of spirometric values was statistically significant (p < 0.0001), and during the follow-up period of (six to 30) months, airway stability was demonstrated in all patients. In terms of acoustic analysis a non-significant difference was found between pre- and post-operative vocal functions (p > 0.05). This management approach offers an alternative to laser procedures, it provides a ’one-stage’ solution for permanent bilateral vocal fold immobility, and avoids terminal loss of voice quality. The authors’ data confirm the safety, ease of performance, and efficiency of ERPTC in patients with bilateral immobile vocal folds.

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