MyMedR

Nonselective Laryngeal Reinnervation versus Type 1 Thyroplasty in Patients with Unilateral Vocal Fold Paralysis: A Single Tertiary Centre Experience

Ab Rani A, Azman M, Ubaidah MA, Mohamad Yunus MR, Sani A, Mat Baki M

J Voice, 2021 May;35(3):487-492.

PMID: 31732294 DOI: 10.1016/j.jvoice.2019.09.017

OBJECTIVE: This study compared the voice outcomes of selected patients with unilateral vocal fold palsy (UVFP) who underwent either nonselective laryngeal reinnervation (LR) or Type 1 thyroplasty (thyroplasty) in a Malaysian tertiary centre using multidimensional voice assessments.

PARTICIPANTS: The study included 16 patients with UVFP who underwent either LR (9 patients) or thyroplasty (7 patients) between 2015 and 2018 who fulfilled the inclusion criteria.

MAIN OUTCOME MEASURES: The outcomes were measured subjectively and objectively with: (1) voice handicap index-10 (VHI-10- Malay version); (2) auditory perceptual evaluation using the breathiness component of Grade, Roughness, Breathiness, Asthenia, Strain scale; (3) maximum phonation time (MPT); and (4) acoustic analysis (jitter%, shimmer%, and NHR) using OperaVOXTM. The outcomes were measured at baseline, 6 and 12-months postoperative. The comparison of outcomes between pre and postoperative of each group was evaluated using one-way ANOVA test. Mann-Whitney test was used to compare the outcomes between the two groups.

RESULTS: Comparison of each group at different time points showed significant improvement of VHI-10 and MPT of LR group between baseline and 12 months (P ≤ 0.05) whereas, the improvement in thyroplasty group was observed at all time points (P ≤ 0.05). When comparing between the two groups at 12 months, the VHI-10 and MPT was significantly better in the LR group than thyroplasty group with P = 0.004 and P = 0.001 respectively. Other outcome measures did not reveal significant difference between the two groups.

CONCLUSION: This observational study showed that LR may be better than thyroplasty in improving VHI-10 and MPT in selected patients with UVFP.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext A rare case of unilateral Cogan's anterior internuclear ophthalmoplegia, upgaze palsy and ataxia caused by dorsal tegmentum lesion at pontomesencephalic junction

Wai YZ, Ng QX, Lim TH, Lim LT

BMC Ophthalmol, 2021 Feb 25;21(1):105.

PMID: 33632162 DOI: 10.1186/s12886-021-01868-9

BACKGROUND: Cogan's anterior internuclear ophthalmoplegia (INO) is characterized by INO with inability to converge and commonly thought to be due to rostral midbrain lesion. A lesion outside midbrain that causes unilateral Cogan's anterior INO combined with upgaze palsy and ataxia are rarely described.

CASE PRESENTATION: A 67-year old male presented with left Cogan's anterior internuclear ophthalmoplegia (INO), left appendicular ataxia and bilateral upgaze palsy. A Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) brain showed a left dorsal tegmental infarct at the level of pontomesencephalic junction.

CONCLUSIONS: This case highlights the clinical importance of Cogan's anterior INO in combination with upgaze palsy and ataxia, and report possible site of lesion in patients with such constellation. Clinicians should consider looking for cerebellar signs in cases of Cogan's anterior INO, apart from just considering localizing the lesion at the midbrain.

Matched MeSH terms: Paralysis

Fulltext Cryptococcal meningoradiculitis presenting with acute flaccid paralysis

Chang CY

Rev Soc Bras Med Trop, 2021;54:e0192 2021.

PMID: 33950130 DOI: 10.1590/0037-8682-0192-2021

Matched MeSH terms: Paralysis

Fulltext Bilateral facial nerve palsy secondary to an atypical presentation of Gullain-BarrÃ© syndrome

Azarisman, S.M.S., Shahrin, T.C.A., Marzuki, A.O., Fatnoon, N.N.A., Rathor, M.Y.

International Medical Journal Malaysia, 2009;8(1):41-44.

MyJurnal

Bilateral simultaneous facial nerve palsy is an extremely rare clinical entity and may occur in association with a variety of neurological, infectious, neoplastic or degenerative disorders. We describe a patient, who presented with facial diplegia and normal reflexes on examination. During the entire hospitalization, he developed no motor weakness and remained ambulatory. Whether treatment is warranted for this and other milder variants of Gullain-BarrÃ© syndrome is also discussed. Atypical presentations with preserved or brisk reflexes, can be a diagnostic dilemma.

Matched MeSH terms: Facial Paralysis

Fulltext Ancient Schwannoma Of The Facial Nerve: An Unusual Histological Variant Of A Rare Disease

Baharudin, A., Din Suhaimi, S., Omar, E.

International Medical Journal Malaysia, 2006;5(2):1-4.

MyJurnal

Schwannomas are benign slow growing lesions arising from the Schwann cells that ensheath the axons of the peripheral, cranial and autonomic nervous systems. Intracranial schwannomas develop from the facial nerve much more rarely than from the vestibular or trigeminal nerves. Ancient schwannoma is an unusual histological variant of this rare disease. A 48 years old man who had recurrent facial nerve paralysis and right external auditory mass is presented in this case report.

Matched MeSH terms: Facial Paralysis

Fulltext Thoracic aortic aneurysm presenting as vocal cord paralysis

Norly, S., Noorizan, Y., Ros’aini, P.

International Medical Journal Malaysia, 2013;12(1):67-68.

MyJurnal

We present a case of 80-year-old man with two-year history of hoarseness of voice secondary to left vocal cord paralysis. CT scanning revealed a saccular thoracic aneurysm compressing the left recurrent laryngeal nerve. A review of literature on Ortner's or cardiovocal syndrome is presented.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Retrospective review of facial nerve schwannomas: the universiti kebangsaan malaysia medical centre experience

Mazita, A., Zahirrudin, Z., Saim, L., Asma, A.

Medicine & Health, 2010;5(2):86-92.

MyJurnal

Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.

Matched MeSH terms: Facial Paralysis

Fulltext Isolated facial palsy due to intra-aural tick (ixodoidea) infestation

Zamzil Amin, A., Baharudin, A., Shahid, H., Din Suhaimi, S., Nor Affendie, M.J.

Archives of Orofacial Sciences, 2007;2(1):51-53.

MyJurnal

A tick in the ear is a very painful condition and removal is difficult because it grips firmly to the external auditory canal or tympanic membrane. Facial paralysis is a rarely reported localised neurological complication of an intra-aural tick infestation. The pathophysiology of localised paralysis is discussed, together with the safe way of handling patients with an intra-aural tick infestation.

Matched MeSH terms: Facial Paralysis

Fulltext Laser posterior cordectomy for bilateral abductor vocal cord palsy : a case report

Mohamad I, Jihan WS, Mohamad H, Abdullah B

Malays J Med Sci, 2008 Jan;15(1):42-3.

PMID: 22589614

Bilateral abductor vocal cord palsy is comparatively a rare vocal cord lesion, especially in a patient with no history of neck mass, previous surgery or trauma. Many patients are not stridulous. A patient presenting with stridor may need emergency airway management before the other treatment is commenced. We report a case of bilateral abductor palsy which required an emergency tracheostomy and subsequently a laser posterior cordectomy.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Facial nerve paralysis: a rare complication of parotid abscess

Sabir Husin Athar PP, Yahya Z, Mat Baki M, Abdullah A

Malays J Med Sci, 2009 Apr;16(2):38-9.

PMID: 22589657

Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72-year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months.

Matched MeSH terms: Facial Paralysis

Fulltext Reoperative thyroid surgery in hospital universiti sains malaysia

Tun M, Salekan K, Sain AH

Malays J Med Sci, 2003 Jan;10(1):86-9.

PMID: 23365506 MyJurnal

From 1996 to 2001, 393 thyroidectomies were performed and 25 (6.4%) patients underwent reoperative thyroid surgery at Hospital Universiti Sains Malaysia. All reoperated patients had undergone one prior thyroid operation. All were females with an average age of 39.1 years (18-61 years). The most frequent indication for reoperation was cancer in resected specimen of an originally misdiagnosed carcinoma treated by partial thyroid resection. Final histological diagnosis of 25 reoperations showed thyroid carcinoma in 22 (88%) cases and multinodular goiter in 3 cases. The overall interval between the initial and the reoperative procedures ranged from 3 weeks to 15 years. There was no post-operative mortality after reoperation. Post-operative complications were discovered in 5 patients, as 3 (12%) of whom had transient hypocalcaemia, one (4%) had wound breakdown and one (4%) had permanent recurrent laryngeal nerve palsy. Reoperative thyroid surgery is an uncommon operation with high complication rate.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Misron K, Balasubramanian A, Mohamad I, Hassan NF

BMJ Case Rep, 2014;2014.

PMID: 24663247 DOI: 10.1136/bcr-2013-201033

Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.

Matched MeSH terms: Vocal Cord Paralysis/etiology*

Fulltext Unilateral adductor vocal cord palsy treated with the titanium vocal fold medializing implant (TVFMI)

Irfan M, Shahid H, Baharudin A, Friedrich G

Med J Malaysia, 2009 Mar;64(1):89-90.

PMID: 19852333 MyJurnal

Vocal cord palsy secondary to recurrent laryngeal nerve injury may be attributable to trauma, infiltrating neoplasm, congenital cardiac anomaly and others. Regardless the causes, majority of unilateral adductor palsy cases are usually managed by speech rehabilitation in order to allow compensation. In selected cases, medialization procedure may be required to achieve a complete glottal closure during phonation. Multiple techniques have been developed to achieve this goal. This case report illustrates the recent advancement in vocal fold medialization procedure, which has not been widely practiced in Malaysia.

Matched MeSH terms: Vocal Cord Paralysis/surgery*

Fulltext Parotid abscess: an unusual cause of facial nerve palsy

Noorizan Y, Chew YK, Khir A, Brito-Mutunayagam S

Med J Malaysia, 2009 Jun;64(2):172-3.

PMID: 20058583 MyJurnal

Facial nerve palsy with a parotid mass is usually associated with malignant neoplasm of parotid gland. Its occurrence as a complication of parotid abscess is extremely rare. A literature review revealed only 16 cases of facial nerve palsy associated with suppurative parotitis or parotid abscess were reported. We present a case of deep parotid abscess which is complicated by facial nerve dysfunction. Underlying neoplasia was excluded.

Matched MeSH terms: Facial Paralysis/etiology*

Fulltext Keratosis obturans complicated with facial nerve palsy: a diagnostic dilemma

Saniasiaya J, Nik Othman NA, Mohamad Pakarul Razy NH

Braz J Otorhinolaryngol, 2016 05 24;86(1):130-132.

PMID: 27269254 DOI: 10.1016/j.bjorl.2016.04.012

Matched MeSH terms: Facial Paralysis/etiology

Chemo-port insertion: A cause of vocal cord palsy

Alazzawi S, Hindi K, Malik A, Wee CA, Prepageran N

Laryngoscope, 2015 Nov;125(11):2551-2.

PMID: 26108861 DOI: 10.1002/lary.25422

We describe extremely rare cases of vocal cord palsy following surgical insertion of a chemo port. Our cohort consisted of patients with cancer who developed hoarseness immediately after central venous line placement for the administration of chemotherapy, with vocal cord palsy confirmed with flexible laryngoscopy. Given the timing, central venous line placement appears to be the most likely cause.

Matched MeSH terms: Vocal Cord Paralysis/etiology*

Methylcobalamin treatment of Bell's palsy

Jalaludin MA

Methods Find Exp Clin Pharmacol, 1995 Oct;17(8):539-44.

PMID: 8749227

Sixty patients with Bell's palsy were included in an open randomized trial. Patients were assigned into three treatment groups: steroid (group 1), methylcobalamin (group 2) and methylcobalamin + steroid (group 3). Comparison between the three groups was based on the number of days needed to attain full recovery, facial nerve scores, and improvement of concomitant symptoms. The time required for complete recovery of facial nerve function was significantly shorter ( p < 0.001) in the methylcobalamin (mean of 1.95 +/- 0.51 weeks) and methylcobalamin plus steroid groups (mean of 2.05 +/- 1.23 weeks) than in the steroid group (mean of 9.60 +/- 7.79 weeks). The facial nerve score after 1-3 weeks of treatment was significantly more severe (p < 0.001) in the steroid group compared to the methylcobalamin and methylcobalamin plus steroid groups. The improvement of concomitant symptoms was better in the methylcobalamin treated groups than the group treated with steroid alone.

Matched MeSH terms: Facial Paralysis/drug therapy*

Fulltext Facial nerve palsy by nasal tumour--a case report

Khanijow VK

Med J Malaysia, 1991 Sep;46(3):259-61.

PMID: 1667539

A case of an adenoid cystic carcinoma of the minor salivary glands of then nasal cavity is reported. The tumour had spread locally and by perineural spread to the internal auditory mentus, causing facial nerve palsy.

Matched MeSH terms: Facial Paralysis/etiology*

Fulltext Severe neurotoxic envenoming by the Malayan krait Bungarus candidus (Linnaeus): response to antivenom and anticholinesterase

Warrell DA, Looareesuwan S, White NJ, Theakston RD, Warrell MJ, Kosakarn W, et al.

Br Med J (Clin Res Ed), 1983 Feb 26;286(6366):678-80.

PMID: 6402200

Five patients were bitten by the Malayan krait Bungarus candidus (Linnaeus) in eastern Thailand or north western Malaya. Two patients were not envenomed but the other three developed generalised paralysis which progressed to respiratory paralysis in two cases, one of which ended fatally. One patient showed parasympathetic abnormalities. Anticholinesterase produced a dramatic improvement in one patient. Another patient probably benefited from paraspecific antivenom. The efficacy of antivenoms and adjuvants such as anticholinesterases in patients with neurotoxic envenoming requires further study.

Matched MeSH terms: Paralysis/etiology

Fulltext Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial

Blackshaw H, Carding P, Jepson M, Mat Baki M, Ambler G, Schilder A, et al.

BMJ Open, 2017 Sep 29;7(9):e016871.

PMID: 28965097 DOI: 10.1136/bmjopen-2017-016871

INTRODUCTION: A functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP.

METHODS AND ANALYSIS: A feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life.

ETHICS AND DISSEMINATION: Ethical approval was received from National Research Ethics Service-Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial.

TRIAL REGISTRATION NUMBER: ISRCTN90201732; 16 December 2015.

Matched MeSH terms: Vocal Cord Paralysis/surgery*

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