title: Diagnosis and management of unilateral thyroarytenoid muscle palsy.
abstract: The objective of this study is to assess and propose a method of diagnosis and management of patients with unilateral thyroarytenoid muscle palsy (TAMP). This is a retrospective review of clinical records. The records of seven patients diagnosed as having idiopathic TAMP were reviewed. Despite the adductive and abductive functions of the vocal folds being within normal range, apparent palsy was seen in the unilateral thyroarytenoid muscle of these patients. TAMP was confirmed by laryngeal electromyography, and the adductive and abductive movements of the vocal folds were evaluated as the mobility of the arytenoid cartilages by three-dimensional computed tomography and endoscopy. Most of patients with TAMP had been diagnosed as having other diseases or normal, and in one patient, it took over 6 years to establish a correct diagnosis. Two patients recovered by conservative treatment; however, in five patients, TAMP remained even after 6 months. In 4 of those 5 patients, treatment with hyaluronic acid injections was performed. In the remaining patient, surgical treatment, namely, nerve-muscle pedicle flap implantation was performed, which resulted in a favorable recovery of phonation. The average maximum phonation time (MPT) of all patients was extended from 11.4 (±4.4) s before treatment to 19.9 (±4.3) s after treatment, and the pitch range was also increased from 25.1 (±7.2) to 34.6 (±5.8) semitones following our management course. Our results indicate that there is a possibility that TAMP can be diagnosed and treated sufficiently. Therefore, further research toward establishing the concept of and treatment for TAMP is anticipated.
authors.affiliation: Department of Otolaryngology, Tokyo Medical University School of Medicine, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. ujimotokn@hotmail.com.
authors.forename: Ujimoto
authors.initials: U
authors.lastname: Konomi
authors.affiliation: Department of Otolaryngology, Tokyo Medical University School of Medicine, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.|Shinjuku Voice Clinic, Enikia Building 4F, 1-1-17 Kabukicho, Shinjuku-ku, Tokyo, 160-0021, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Tokashiki
authors.affiliation: Department of Otolaryngology, Tokyo Medical University School of Medicine, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.|Hiramastu ENT Clinic, Diamond Building 2F, 1-7-1 Nogaya, Machida-shi, Tokyo, 195-0053, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hiramatsu
authors.affiliation: Kumada Clinic, L-First Building 3F, 4-2-6 Nishi-azabu, Minato-ku, Tokyo, 106-0031, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kumada
mesh_terms: D000328:Adult; D001193:Arytenoid Cartilage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D055154:Dysphonia / Q000209:etiology / Q000628:therapy; D004576:Electromyography; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D021621:Imaging, Three-Dimensional; D007821:Laryngeal Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007828:Laryngoscopy; D008297:Male; D010699:Phonation; D012189:Retrospective Studies; D049489:Stroboscopy; D013524:Surgical Flaps / Q000294:innervation; D014057:Tomography, X-Ray Computed; D055675:Viscosupplements / Q000627:therapeutic use; D014826:Vocal Cord Paralysis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: Hyaluronic acid injection; Laryngeal electromyography; Nerve–muscle pedicle flap transfer; Recurrent nerve paresis; Thyroarytenoid muscle paralysis; Thyroplasty, 3DCT; Voice therapy