The correction of paralytic dysphonia is primarily a mechanical problem requiring movement of the paralyzed vocal cord to the midline so that the functioning cord can meet it and effectively close the glottis. Intracordal Teflon@ injection is now the treatment of choice. This paper reviews 135 patients who received Teflon@ injections of the vocal cord durin the last five years. Ei hty one percent of the patients with dysphonia recovered a normal sotd phonatory voice a n b 9f3% were clinically improved at least one step. Pure laryngeal paralysis was virtually always improved, usually to a normal phonatory voice. Although some patients with hoarseness after surgical or blunt trauma were improved, the results were not as consistent. Aspiration was decreased or eliminated in the majority of patients unless there was too much laryngeal scarring to permit vocal cord repositionment or unless multiple cranial nerve or cerebellum deficits were present.
Despite the absence of an overt or submucous cleft of the palate, certain children manifest persistent nasality after an adenoidectomy. Removal of the adenoid tissue has unmasked an underlying anatomic or physiologic deficit in the velopharyngeal mechanism. In an effort to identify the premonitory signs of potential difficulties, 40 children with suspected velopharyngeal dysfunction were studied prior to consideration of an adenoidectomy. Four evaluative techniques were used: (1) clinical speech evaluation, (2) cinefluorography, (3) cephalometrics, and (4) coordination pattern recordings. Each method of assessment contributed information that can serve as an “alert” to the potential consequences of a total adenoidectomy. The findings suggest the importance of careful evaluations and caution when considering a total adenoidectomy for children in whom there may exist only marginal indications of a potential velopharyngeal dysfunction. Where necessary for preservation of a child’s hearing, a lateral adenoidectomy, maintaining the midline adenoid pad, would seem indicated.
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