Bilateral Vocal Fold Paralysis in Myasthenia Gravis: A Case Report and Literature Review

AbstractObjectives:To increase awareness of cervical osteophytes as an extremely rare cause of recurrent laryngeal nerve palsy; to outline the clinical approach to patients with unilateral vocal fold paralysis and to provide an update on the current management of osteoarthritis and osteophytes.Case report:An elderly man presented with right unilateral vocal fold immobility and a small phonatory gap. By a diagnosis of exclusion, a cervical osteophyte at the level of the sixth and seventh cervical vertebrae was shown to be the cause. The patient responded to speech therapy and no further intervention was required.Method:A literature review, using Medline, identified only one previously published case of vocal fold paralysis due to osteophytes secondary to osteoarthritis.Conclusion:The aetiology of unilateral paralysis of the hemilarynx must be fully investigated, as the innervating system has a protracted course, particularly on the left side. Degenerative cervical spine disease, although rare, should be considered as part of the differential diagnosis.

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Epithelioid Hemangioendothelioma Presenting as Unilateral Vocal Fold Paralysis: A Case Report and Literature Review

Ear Nose & Throat Journal ◽

10.1177/0145561319873914 ◽

2019 ◽

pp. 014556131987391

Author(s):

Justin T. Lui ◽

Anita T. Kang ◽

Lisa M. DiFrancesco ◽

S. Joseph Warshawski ◽

Derrick R. Randall

Keyword(s):

Case Report ◽

Literature Review ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Epithelioid Hemangioendothelioma ◽

Unilateral Vocal Fold Paralysis

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Efficacy of Arytenoidectomy after Suture Lateralisation Failure in Patients with Bilateral Vocal Cord Paralysis

Case Reports in Otolaryngology ◽

10.1155/2020/8822164 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Shinsuke Suzuki ◽

Takechiyo Yamada

Keyword(s):

Case Report ◽

Vocal Cord ◽

Mucous Membrane ◽

Vocal Fold ◽

Vocal Cord Paralysis ◽

Vocal Fold Paralysis ◽

Bilateral Vocal Cord Paralysis ◽

Vocal Function ◽

Case Methods ◽

Bilateral Vocal Fold Paralysis

Background. Endolaryngeal suture lateralisation is an ideal operation for bilateral vocal fold paralysis. However, restenosis owing to breakage and slippage of suture can sometimes occur. In such a case, methods that are more effective in expanding the glottis, including arytenoidectomy, must be selected. Case Report. Herein, we report two female patients aged 86 and 54 years who presented with bilateral vocal cord paralysis and who had restenosis after suture lateralisation. Endoscopic partial arytenoidectomy was performed, and satisfactory outcomes were obtained. This method maintains the height of the arytenoid and preserves its sensation by leaving a part of the cartilage and mucous membrane. Conclusion. Endoscopic partial arytenoidectomy is effective for securing the airway while preserving vocal function and preventing aspiration. This technique is suitable for patients with restenosis after they have undergone endolaryngeal suture lateralisation.

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Acute stridor due to bilateral vocal fold paralysis as a presenting sign of myasthenia gravis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100120730 ◽

1992 ◽

Vol 106 (8) ◽

pp. 737-738 ◽

Cited By ~ 18

Author(s):

James W. Fairley ◽

Marianne Hughes

Keyword(s):

Myasthenia Gravis ◽

Medical Treatment ◽

Vocal Fold ◽

Vocal Folds ◽

Vocal Fold Paralysis ◽

Bilateral Vocal Fold Paralysis ◽

Abductor Paralysis ◽

Prompt Diagnosis

AbstractWe describe a case of myasthenia gravis in a 46-year-old man presenting as acute stridor with bilateral abductor paralysis of the vocal folds. Prompt diagnosis and medical treatment with pyridostigmine avoided the need for tracheostomy. It is important to remember the possibility of myasthenia gravis in cases of stridor due to bilateral vocal fold paralysis, since effective medical treatment is available.

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Selective Laryngeal Reinnervation for Bilateral Vocal Fold Paralysis

Case Medical Research ◽

10.31525/ct1-nct03980275 ◽

2019 ◽

Author(s):

Keyword(s):

Vocal Fold ◽

Vocal Fold Paralysis ◽

Bilateral Vocal Fold Paralysis ◽

Laryngeal Reinnervation

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Confounding case of seromucinous hamartoma

BMJ Case Reports ◽

10.1136/bcr-2020-240460 ◽

2021 ◽

Vol 14 (3) ◽

pp. e240460

Author(s):

Neal Rajan Godse ◽

Giuseppe Vittorio Staltari ◽

Katherine Doeden ◽

Grant Shale Gillman

Keyword(s):

Myasthenia Gravis ◽

Vocal Fold ◽

Cranial Nerves ◽

Vocal Fold Paralysis ◽

Seromucinous Hamartoma ◽

Cranial Neuropathies ◽

Receptor Antibodies ◽

Bony Erosion ◽

Ct And Mri ◽

Anti Acetylcholine

A 67-year-old man presented with progressive diplopia. On evaluation, he was noted to have bilateral palsies of cranial nerves III, IV and VI as well as a unilateral right true vocal fold paralysis. CT and MRI studies demonstrated a T2-bright left ethmoid mass with no evidence of bony erosion. Direct visualisation demonstrated a polypoid appearing mass of the left sphenoethmoid recess. Operative biopsy was pursued with final pathology demonstrating benign seromucinous hamartoma. Subsequent blood work demonstrated high titres of anti-acetylcholine receptor antibodies consistent with myasthenia gravis. The patient was started on pyridostigmine with improvement in his ocular cranial neuropathies.

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