1. Paralysis

2. Paralysis ( plegia ) - Paralysis is the complete loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage as well as motor.
Paresis- Reduction in the maximum force of muscular contraction and in muscular force on repeated contraction.

3. Paralysis Hemiplegia Hemiparesis Paralysis on one side of body
Lesion in corticospinal tract
Contralateral motor control
Hemiparesis
Weakness or partial paralysis
Less severe than Hemiplegia

4. Vocal Paralysis: What is it?
Vocal fold paralysis and paresis result from abnormal nerve input to the voice box muscles (laryngeal muscles).  
Paralysis is the total interruption of nerve impulse resulting in no movement of the muscle
Paresis (also possible) is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s).

5. Vocal Paralysis What nerves are involved?
Superior Laryngeal Nerve (SLN): carries signals to the cricothyroid muscle which adjusts vocal cord tension for high/low pitches
Recurrent Laryngeal Nerve (RLN): signals to different voice box muscles responsible for opening vocal folds (as in breathing, coughing), closing vocal folds for vocal fold vibration during voice use, and closing vocal folds during swallowing.

6. Vocal Paralysis Not simply inability to speak
Can also affect: ability to swallow
cause shortness of breath
noisy breathing
hoarseness
unclear “breathy” voice
breath use in sound production

7. Vocal Paralysis How is it diagnosed?
Laryngeal electromyography (LEMG): measures electrical currents in voice box muscles resulting from nerve input information. Measuring and looking at patterns in electrical currents show whether there is repair of nerve inputs (re-innervation) and the  extent of the nerve lesion or problem.   It works through the insertion of small needles that can measure electrical currents in the vocal cord muscles. In LEMG testing, patients perform a number of tasks that would normally produce typical activity in the vocal muscles.

8. Vocal Cord Paralysis Causes in the CNS Causes in the base of skull
Causes in Parapharyngeal space
Causes in the neck.
Causes in the chest.
Neurological causes.

9. D/D V.C. Paralysis - Causes in CNS
Infections -Encephalitis, meningitis.
Trauma
Vascular causes - infarction., hemorrhage, aneurysm.

10. D/D V.C. Paralysis - Causes in base of skull
Inflammations - Chronic specific
Trauma
Bone disease e.g., paget’s disease osteopetrosis, osteogenosis imperfecta
TUMOURS
Primary- glomus jugulare.
Secondary- parotid, Nasopharynx.

11. D/D V.C. Paralysis - Causes in Parapharyngeal Space
Inflammations - Parapharyngeal abscess
Trauma
Tumour- Parotid, Nasopharynx, Secondaries.

12. D/D V.C. Paralysis - Causes in the Neck
Trauma:
Surgical thyroid, larynx, esophagus etc.
Physical blunt & penetrating.
Inflammation,
Non specific and specific.
Tumours.
Larynx, esophagus, thyroid, trachea, lymphomas and secondaries.

13. D/D V.C. Paralysis - Causes in Chest (left side only)
Tumours
Carcinoma
Retrosternal goiter
Ca esophagus
Mediastinal malignancy
Tuberculosis
Aortic aneurysm
Rt. Ventricular hypertrophy

14. TYPES OF PARALYSIS UNILATRAL ABDUCTOR PARALYSIS
UNILATRAL ADDUCTOR PARALYSIS
BILATRAL ABDUCTOR PARALYSIS
BILATRAL ADDUCTOR PARALYSIS

15. UNILATRAL ABDUCTOR PARALYSIS
1. Paralysis of recurrent laryngeal
nerve
2. Vocal cord lies in paramedian position
3. Initial hoarseness
4. No regurgitation
5. Vocal cord compensation occurs leading to improvement of voice
6. Teflon paste injection---- Treatment

16. UNILATRAL ADDUCTOR PARALYSIS
1. Paralysis of both superior and recurrent laryngeal
nerves
2. Vocal cord lies in Lateral (cadaveric) position
3. Weak husky voice
4. There is aspiration of food and fluid
5. Vocal cord compensation occurs leading to improvement of voice
6. Teflon paste injection usually not possible. Medialization of vocal cord or reverse cordopexy ---- Treatment

17. BILATRAL ABDUCTOR PARALYSIS
1.Paralysis of both recurrent laryngeal
nerves
2. Thyroid surgery - cause
3. Both vocal cord lies in paramedian position
4. Severe dyspnoea and stridor.
5. Voice is good and there is no regurgitation
6. Vocal cord compensation may occurs leading to improvement
7. Immediate tracheostomy followed by laser, woodman, s operation or aytenoidectomy or valved tracheostomy--- Treatment

18. BILATRAL ADDUCTOR PARALYSIS
1. Paralysis of combined both recurrent and superior laryngeal nerves
2. Psychiatric Illness or widespread neurological lesion or neoplastic lesion in the base of skull, upper neck etc.
3. Both vocal cord lies in lateral (cadaveric) position
4. Severe regurgitation of food and fluid.
5. Voice is breathy
6. Vocal cord compensation may occurs leading to improvement
7. If compensation does not occur than total laryngectomy and epiglottopexy ---- Treatment