2Paralysis ( 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.
3Paralysis Hemiplegia Hemiparesis Paralysis on one side of body Lesion in corticospinal tractContralateral motor controlHemiparesisWeakness or partial paralysisLess severe than Hemiplegia
4Vocal 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 muscleParesis (also possible) is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s).
5Vocal Paralysis What nerves are involved? Superior Laryngeal Nerve (SLN): carries signals to the cricothyroid muscle which adjusts vocal cord tension for high/low pitchesRecurrent 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.
6Vocal Paralysis Not simply inability to speak Can also affect: ability to swallowcause shortness of breathnoisy breathinghoarsenessunclear “breathy” voicebreath use in sound production
7Vocal 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.
8Vocal Cord Paralysis Causes in the CNS Causes in the base of skull Causes in Parapharyngeal spaceCauses in the neck.Causes in the chest.Neurological causes.
10D/D V.C. Paralysis - Causes in base of skull Inflammations - Chronic specificTraumaBone disease e.g., paget’s disease osteopetrosis, osteogenosis imperfectaTUMOURSPrimary- glomus jugulare.Secondary- parotid, Nasopharynx.
11D/D V.C. Paralysis - Causes in Parapharyngeal Space Inflammations - Parapharyngeal abscessTraumaTumour- Parotid, Nasopharynx, Secondaries.
12D/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.
13D/D V.C. Paralysis - Causes in Chest (left side only) TumoursCarcinomaRetrosternal goiterCa esophagusMediastinal malignancyTuberculosisAortic aneurysmRt. Ventricular hypertrophy
15UNILATRAL ABDUCTOR PARALYSIS 1. Paralysis of recurrent laryngealnerve2. Vocal cord lies in paramedian position3. Initial hoarseness4. No regurgitation5. Vocal cord compensation occurs leading to improvement of voice6. Teflon paste injection---- Treatment
16UNILATRAL ADDUCTOR PARALYSIS 1. Paralysis of both superior and recurrent laryngealnerves2. Vocal cord lies in Lateral (cadaveric) position3. Weak husky voice4. There is aspiration of food and fluid5. Vocal cord compensation occurs leading to improvement of voice6. Teflon paste injection usually not possible. Medialization of vocal cord or reverse cordopexy ---- Treatment
17BILATRAL ABDUCTOR PARALYSIS 1.Paralysis of both recurrent laryngealnerves2. Thyroid surgery - cause3. Both vocal cord lies in paramedian position4. Severe dyspnoea and stridor.5. Voice is good and there is no regurgitation6. Vocal cord compensation may occurs leading to improvement7. Immediate tracheostomy followed by laser, woodman, s operation or aytenoidectomy or valved tracheostomy--- Treatment
18BILATRAL ADDUCTOR PARALYSIS 1. Paralysis of combined both recurrent and superior laryngeal nerves2. 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) position4. Severe regurgitation of food and fluid.5. Voice is breathy6. Vocal cord compensation may occurs leading to improvement7. If compensation does not occur than total laryngectomy and epiglottopexy ---- Treatment