Article Figures & Data
Figures
- Fig 1.
Schematic of the main categories of procedures for treating vocal cord paralysis: injection laryngoplasty (A), medialization laryngoplasty (B), and arytenoid adduction (C).
- Fig 2.
Hyaluronic acid gel. Axial (A) and coronal (B) contrast-enhanced CT at the level of the vocal folds demonstrates fluid attenuation material within the left vocal fold (black arrow).
- Fig 3.
Micronized collagen (Cymetra) approximately 11 months after injection. A, Unenhanced T1-weighted image at the level of the true vocal folds demonstrates T1 hyperintensity within the right vocal fold (arrow; due to volume averaging, portions of the false cord are also partially seen). B, T2-weighted image demonstrates a hyperintense region in the true vocal fold on the right corresponding to the site of injection (arrow).
- Fig 4.
Calcium hydroxylapatite. A, Axial contrast-enhanced CT with a bone algorithm demonstrates hyperattenuating material in the region of the left vocal fold (black arrow). B, Axial positron-emission tomography demonstrates hypermetabolism at the site of the injected material, which can be a false-positive finding for malignant disease (white arrow).
- Fig 5.
Autologous fat. A, Coronal CT at the level of the vocal folds demonstrates transglottic carcinoma on the right (white dotted line). B, Coronal CT posttreatment shows low-attenuation material within the right vocal fold status post fat augmentation (arrow).
- Fig 6.
Teflon. A, Axial CT demonstrates hyperattenuating material in the bilateral vocal folds (arrows) consistent with Teflon injection. B, Axial CT in a different patient status post Teflon injection into the right vocal fold demonstrates a slightly nodular contour (arrowheads) consistent with granuloma formation, a common complication of Teflon.
- Fig 7.
Montgomery Implant. A, Axial CT demonstrates a Montgomery Implant (black arrow) and appropriate medialization of the right vocal cord. Note the triangular configuration of the Montgomery Implant. B, Axial contrast-enhanced T1-weighted MR imaging in a different patient demonstrates triangular hypointensity adjacent to the left vocal fold, representing the Montgomery Implant (white arrow), with appropriate medialization of left vocal fold.
- Fig 8.
PTFE. Axial CT demonstrates hyperattenuating PTFE in the region of the right vocal fold with appropriate medialization of the right vocal fold. Note the slight nodular contour of the medial margin of the vocal fold (smaller arrows) indicating mild granuloma formation in this patient.
- Fig 9.
Malpositioned Montgomery Implant. Axial CT demonstrates an externally rotated Montgomery Implant, which is not flush against the thyroid window (arrow).
- Fig 10.
Malpositioned Montgomery Implant. Axial (A) and coronal (B) images demonstrate a Montgomery Implant that is displaced superiorly into the aryepiglottic fold and false cord (black arrow). White arrow indicates the appropriate level of the implant.
- Fig 11.
Arytenoid adduction. Preoperative axial CT image (A) and postoperative axial CT image (B) demonstrate the medially rotated (adducted) left arytenoid cartilage (white arrow) compared with the preoperative position (black arrow). Note that adduction turns the arytenoid in toward the vocal cord to ensure that no air leaks through the posterior glottic gap. This result helps patients achieve a more robust voice quality after the operation.
Tables
Procedures Indications Techniques Imaging Findings Injection laryngoplasty Temporary correction of glottic incompetence due to unilateral vocal fold paralysis and long-term correction of mild-moderate glottic insufficiency Percutaneous, transnasal, or peroral injection of filler material into the vocal cord or paraglottic space Varies depending on agent injected; also refer to the text and Table 2 Medialization laryngoplasty Permanent correction; should be reserved for cases of vocal fold paralysis in which recovery of motion is definitively not expected (time >6 months from onset, surgical recurrent nerve sacrifice, or malignant invasion) Insertion of an implant into the vocal fold through a window in the thyroid, which results in displacement of the paralyzed vocal fold to a more medial position The implants typically used appear as hyperattenuating on CT and low signal on T1- and T2-weighted sequences, with a triangular shape on axial images; a defect in the adjacent thyroid cartilage may be visible Arytenoid adduction (adduction arytenopexy) To enhance posterior glottal closure in patients with paralytic dysphonia by reproducing lateral cricoarytenoid muscle function; can be performed in conjunction with medialization laryngoplasty The inner perichondrium of the thyroid cartilage is opened and the muscular process of the arytenoid is identified and sutured to the thyroid or cricoid cartilage Medially rotated (adducted) arytenoid cartilage and narrowing of the posterior glottic gap Agents Longevity Imaging Findings Hyaluronic acid gels (Restylane, Hylaform) Temporary Nearly fluid attenuation on CT; T1 hypointense and T2 hyperintense, similar to fluid on MRI; may display peripheral enhancement initially Micronized cadaveric dermis (Cymetra) Temporary T1 and T2 hyperintense within the first year of injection Bovine collagen preparations (Zyplast) Temporary Generally fluid attenuation on CT; T1 hypointense and T2 hyperintense, similar to fluid on MRI; may display peripheral enhancement initially Calcium hydroxylapatite (Radiesse Voice) Long-lasting High attenuation on CT (280–700 HU); hypermetabolic on 18FDG-PET Autologous fat Long-lasting Attenuation and signal characteristics of adipose tissue Teflon Permanent Globular high attenuation on CT (200–400 HU range)
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