title: Unilateral true vocal fold synkinesis presenting with airway obstruction.
abstract: OBJECTIVE
  We present a case series of 10 patients with unilateral true vocal fold paralysis who presented with airway obstruction.
  
  
  METHODS
  A retrospective review of the authors' patients at 2 institutions with unilateral true vocal fold motion impairment was carried out over a 10-year period. Of these, 10 patients were identified who presented with stridor and dyspnea as a result of synkinesis. Six cases were a result of thyroidectomy, 1 case resulted from recurrent laryngeal nerve section for spasmodic dysphonia, 1 case occurred after anterior cervical diskectomy and fusion, and in 2 cases no cause was identified.
  
  
  RESULTS
  Three patients underwent tracheotomy. Two patients underwent partial arytenoidectomy. Seven patients underwent botulinum toxin injection; 2 were treated with breathing therapy, and in 1 case breathing therapy was recommended. Seven patients underwent treatment with more than 1 method.
  
  
  CONCLUSIONS
  Unilateral vocal fold paralysis may present with airway obstruction as a result of synkinesis. Treatment should be incremental and starts with breathing therapy and botulinum toxin injection. Partial arytenoidectomy or tracheotomy may be necessary for refractory cases.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, PA 19140, USA.
authors.forename: Roya
authors.initials: R
authors.lastname: Azadarmaki
authors.forename: Natasha
authors.initials: N
authors.lastname: Mirza
authors.forename: Ahmed M S
authors.initials: AM
authors.lastname: Soliman
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology*; D015331:Cohort Studies; D004417:Dyspnea / Q000209:etiology; D004576:Electromyography; D005260:Female; D006801:Humans; D007821:Laryngeal Muscles / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012135:Respiratory Sounds / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D046608:Synkinesis / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy