Diseases Of The Nose Throat And Ear

188 THE LARYNX, BRONCHI AND OESOPHAGUS

2. Crico-arytenoid Arthrodesis. Using a laryngofissure approach (in whicl
the thyroid cartilage is split vertically near the midline) the arytenoid i<
exposed, the crico-arytenoid joint opened and roughened, and the arytenoic
(after being rotated medially) is arthrodesed to the cricoid by means of j
Montgomery screw.

3. Implant Procedures. Via a laryngofissure approach the internal peri
chondrium of the thyroid cartilage lamina is stripped off and the space createc
is filled with either the sternohyoid muscle or with a free cartilage implant
the cartilage being obtained from the upper half of the thyroid lamina.

BILATERAL COMPLETE PARALYSIS

This is the least common condition and both cords lie in the cadaveric
position. There is aphonia which does not recover, and there is no possibilitj
of developing a positive subglottic pressure. This means that the patiem
cannot control coordinated swallowing and food is inhaled, a situatior
further compounded by an inability to produce a good cough.

TREATMENT. Nearly all patients suffer from bronchopneumonia and wil
require a tracheostomy for removing pulmonary secretions and debris. Th<
swallowing and inhalation problem is not helped by either Teflon injections 01
cricopharyngeal myotomy. If the situation is severe it may be necessary to do a
total laryngectomy. In cases requiring this form of treatment the larynx anc
upper trachea (i.e. the trachea above the tracheostomy tube) will be oedema-
tous and infected because they will have been acting as a sump.

UNILATERAL INCOMPLETE (ABDUCTOR) PARALYSIS

This paralysis, in which one vocal cord is fixed in the paramedian position
{Fig. 93), is most commonly due to a bronchial carcinoma at the left hilum.

Fig. 93. Laryngeal paralysis. Mirror image to show
left vocal cord in paramedian position.
(CX = centre line.)

Every patient who is discovered to have such a paralysis in the absence of any
other discoverable cause must be regarded as having a left-sided bronchial
carcinoma until proved otherwise. Often it takes many months for such a
carcinoma to come to light at radiography and so early bronchoscopy with