title: Use of bilateral suture lateralisation technique in severe paradoxical vocal fold movement, allowing removal of long-term tracheostomy: case report.
abstract: OBJECTIVE
  We report a novel bilateral suture lateralisation technique that allowed permanent tracheostomy decannulation in a patient with severe paradoxical vocal fold movement.
  
  
  METHODS
  A 45-year-old woman presented to the accident and emergency department with worsening shortness of breath. Flexible nasoendoscopy revealed limited vocal fold abduction and an emergency tracheostomy was sited; this was subsequently changed to a long-term Silver Negus tube. Her tracheostomy care was complicated by discomfort and dislodgement. The diagnosis of paradoxical vocal fold movement was only made when the patient presented to our department. Cognitive behaviour therapy and botulinum toxin injection were tried without success. A right vocal fold lateralisation procedure was performed, which enabled temporary tracheostomy decannulation. A left vocal fold lateralisation procedure was subsequently performed and the patient was successfully decannulated, with significant improvement in quality of life.
  
  
  CONCLUSIONS
  Paradoxical vocal fold movement is a rare condition that is most commonly managed by biofeedback sessions, relaxation manoeuvres or botulinum toxin injection. However, in cases similar to ours in which these treatments are unsuccessful, we suggest a 'last resort' technique to manage this rare condition.
authors.affiliation: Department of ENT, Charing Cross Hospital, London, UK. jmv04@imperial.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: van Griethuysen
authors.forename: C
authors.initials: C
authors.lastname: Al Yaghchi
authors.forename: G
authors.initials: G
authors.lastname: Sandhu
mesh_terms: D060666:Airway Extubation; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D004417:Dyspnea / Q000209:etiology / Q000601:surgery*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D013536:Suture Techniques; D014139:Tracheostomy / Q000009:adverse effects / Q000295:instrumentation / Q000523:psychology; D016896:Treatment Outcome; D014827:Vocal Cords / Q000503:physiopathology* / Q000601:surgery
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins