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Journal of Voice
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    • Unilateral Vocal Fold Immobility Disorders

    Article Type

    • Research Article130
    • Review Article2
    • Rapid Communication1

    Publication Date

    Author

    • Sataloff, Robert T8
    • Heman-Ackah, Yolanda D7
    • Rosen, Clark A5
    • Benninger, Michael S4
    • Tucker, Harvey M4
    • Casiano, Roy R3
    • Dean, Carole M3
    • Eysholdt, Ulrich3
    • Heuer, Reinhardt J3
    • Konomi, Ujimoto3
    • Murry, Thomas3
    • Stemple, Joseph C3
    • Anderson, Timothy D2
    • Barr, Arlene2
    • Bergamini, G2
    • Bohr, Christopher2
    • Bryson, Paul C2
    • Caroline, Malka2
    • Hogikyan, Norman D2
    • Rontal, Eugene2
    • Rontal, Michael2
    • Rosen, Clark2
    • Abad-Marco, Ana1
    • Adam, Stewart1
    • Adorni, Fulvio1

    Journal

    • Journal of Voice133

    Keyword

    • Vocal fold paralysis34
    • Dysphonia19
    • Vocal fold paresis19
    • Thyroplasty15
    • Unilateral vocal fold paralysis14
    • Larynx11
    • Voice11
    • Laryngeal electromyography10
    • Injection laryngoplasty9
    • Recurrent laryngeal nerve8
    • Vocal cord paralysis8
    • Voice therapy8
    • Arytenoid adduction7
    • Medialization laryngoplasty7
    • Paralysis7
    • Vocal fold immobility6
    • Hoarseness5
    • Hyaluronic acid4
    • Voice quality4
    • Endotracheal intubation3
    • Vocal-fold paralysis3
    • Acoustic analysis2
    • Arytenoid dislocation2
    • Electroglottography2
    • Objective measures2

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    • Open Access
    Journal of Voice Source Readings

    Unilateral Vocal Fold Immobility Disorders

    Karen Kost, MD

    This collection contains 133 articles, encompassing unilateral vocal fold paralysis (UVFP), paresis and immobility. The term immobility is sometimes used interchangeably with paralysis. The vast majority of the articles pertain to paralysis and immobility, with only a few on paresis, which appears to have gained interest in the last 15 years.  A review of the number and breadth of the articles provides an appreciation of the sheer wealth and depth of information found in this particular collection. There are references covering a wide range of topics related to UVFP from the etiology, vocal evaluation, diagnosis, and treatment, to voice outcomes and prognosis.

    The etiology of UVFP has been addressed in some of the articles, describing the importance of iatrogenic causes arising from thoracic and thyroid operations, as well as anterior c-spine approaches. Malignancies involving the chest also account for a substantial number of cases. Less frequent causes which have been reported include intubation, cardiomegaly, syphilis, myasthenia gravis and Lyme disease.  As described in some of the articles, the diagnosis of UVFP is often based on visual inspection with videostroboscopy, with the addition of a large number and variety of acoustic voice measures and phonatory tasks, such as maximum phonation time, perturbation measures, aerodynamic evaluation, cepstral analysis, GRBAS, Voice Handicap Index and Voice related Quality of life. Such measures also are used to evaluate voice outcomes, both perceptually and objectively, following various interventions.  In the last decade, laryngeal electromyography (EMG) has gained considerable attention in the literature as a very useful tool in both the evaluation, diagnosis, management and prognostication of laryngeal movement disorders such as paralysis and paresis.

    The value of voice therapy in UVFP as the sole intervention or in conjunction with other therapeutic options has been reviewed extensively in several references. Almost uniformly, the overriding theme is that voice therapy is extremely beneficial with measurable improvements in voice outcomes, particularly when introduced early.   

    Treatment of UVFP has been a subject of great interest and debate from very early in the history of the Journal of Voice. Some of the earlier references reported successful laryngeal pacing in canines and suggested that this approach could have clinical applications in UFVP. Anatomic studies of the recurrent laryngeal nerve (RLN), as well as work on the effects of transecting branches to intrinsic laryngeal muscles, may have been precursors to later substantial interest in reinnervation strategies using nerve transfer techniques and free nerve grafts.

    Throughout the 24-year span of this collection, a great deal of attention has been focused on the treatment of UVFP using the Ishiiki Type I thyroplasty with or without additional measures. Several modifications of the originally described technique have been suggested, including alterations in window placement/size, implant design and materials, and management of the strap muscles and perichondrium.  Many of these continue to be subjects of ongoing debate. Implants have been described as successful in conjunction with injection augmentation, both pre and postoperatively. Technical innovations continued early in the millenium with the description of an ‘adjustable laryngeal implant’ as well as a paper describing the use of expanded polytetrafluoroethylene (Goretex) strips through a minifenestration or very small window. The addition of arytenoid adduction (AA) to Type I thyroplasty for the treatment of UVFP with a large posterior gap also was described; it continues to generate controversy regarding the need, indications and benefits of AA. Type I thyroplasty with concurrent nerve muscle pedicle reinnervation has been advanced as a means of providing stable long-term results.

    Injection laryngoplasty as a medialization technique features very prominently in this collection, and has been the subject of intense interest, particularly in the last 2 decades. With the increasing appreciation of Teflon-related complications came the search for improved biocompatible materials. Lipoinjection using autologous fat was initially touted as a ‘permanent’, well tolerated procedure with excellent results. However, the procedure usually is performed in the operating room, and it has become clear that variable resorption often necessitates reinjection.  Several other injection materials of various longevity were introduced, including collagen, gelfoam, Cymmetra. These have largely been supplanted by the relatively more recent hyaluronic acid-based injections which are extremely well tolerated and can be repeated as required. Also described is the longer lasting calcium hydroxylapatite (CaHA) injection. Although initially described as very safe, there have been some articles describing complications associated with the product. Injection laryngoplasty is both attractive and popular because it can be done safely in the office, often at the first visit, providing immediate results. Indeed, early intervention with injection augmentation has been noted, in several articles, to preclude the need for Type I thyroplasty. The choice of injection material, the method of injection, and the fate of the injected substance continue to be subjects of much debate in the articles within this collection.

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    • Research Article

      Unilateral Vocal Fold Paralysis in Parkinson Disease: Case Report and Review of the Literature

      Journal of Voice
      Vol. 32Issue 6p763–766Published online: October 24, 2017
      • Abdul-Latif Hamdan
      • Elie Khalifee
      • Georges Tabet
      Cited in Scopus: 2
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        The objective of this study was to report the first case of unilateral vocal fold paralysis in a patient with Parkinson disease (PD) and to review the literature.
        Unilateral Vocal Fold Paralysis in Parkinson Disease: Case Report and Review of the Literature
      • Research Article

        The 3D Printing of the Paralyzed Vocal Fold: Added Value in Injection Laryngoplasty

        Journal of Voice
        Vol. 32Issue 4p499–501Published online: August 18, 2017
        • Abdul-Latif Hamdan
        • Ghassan Haddad
        • Ali Haydar
        • Ramsey Hamade
        Cited in Scopus: 7
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          Three-dimensional (3D) printing has had numerous applications in various disciplines, especially otolaryngology. We report the first case of a high-fidelity 3D-printed model of the vocal cords of a patient with unilateral vocal cord paralysis in need of injection laryngoplasty.
          The 3D Printing of the Paralyzed Vocal Fold: Added Value in Injection Laryngoplasty
        • Research Article

          Lewis-Sumner Syndrome Manifesting as Unilateral Vocal Fold Paresis and Laryngeal Fasciculations

          Journal of Voice
          Vol. 32Issue 3p356–358Published online: August 3, 2017
          • Jérôme R. Lechien
          • Camille Finck
          Cited in Scopus: 1
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          Lewis-Sumner syndrome (LSS) is a rare disease characterized by asymmetrical and multifocal mononeuropathy commonly located in the upper limbs. Some rare cases affecting cranial nerve have been described, but LSS is unknown to affect especially laryngeal nerves. This paper presents the first case of unilateral vocal fold paresis caused by an LSS in a 59-year-old man complaining of dysphonia, breathy voice, and vocal fatigue. Epidemiology, clinical features, diagnosis, and treatment will be described.
        • Research Article

          Medialization Laryngoplasty After Injection Augmentation

          Journal of Voice
          Vol. 32Issue 2p249–255Published online: July 3, 2017
          • Valeria Silva Merea
          • Solomon Husain
          • Lucian Sulica
          Cited in Scopus: 6
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            This study aims to assess the effect of vocal fold injection augmentation (IA) on subsequent medialization laryngoplasty (ML).
            Medialization Laryngoplasty After Injection Augmentation
          • Research Article

            Pressure and Flow Comparisons Across Vocal Pathologies

            Journal of Voice
            Vol. 32Issue 1p95–100Published online: June 29, 2017
            • Linda Carroll
            • Ann Rooney
            • Thomas J. Ow
            • Melin Tan
            Cited in Scopus: 2
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              The aim of this study was to aid in the distinction among hyperadductive dysphonias by evaluating peak glottal pressure, release burst, and mid and final airflow values across repeated /pa/ syllable trains.
              Pressure and Flow Comparisons Across Vocal Pathologies
            • Research Article

              Does Even Low-Grade Dysphonia Warrant Voice Center Referral?

              Journal of Voice
              Vol. 31Issue 6p753–756Published online: April 7, 2017
              • Resha S. Soni
              • Barbara Ebersole
              • Nausheen Jamal
              Cited in Scopus: 2
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                Data regarding the referral of dysphonic patients to specialty voice clinics are limited. The objective of this study is to examine the relationship between low perceptual dysphonia severity and subtle laryngeal findings to discern if this can help guide referral.
                Does Even Low-Grade Dysphonia Warrant Voice Center Referral?
              • Review Article

                A Systematic Review of Voice Therapy: What “Effectiveness” Really Implies

                Journal of Voice
                Vol. 31Issue 3p392.e13–392.e32Published online: November 15, 2016
                • Maude Desjardins
                • Lucinda Halstead
                • Melissa Cooke
                • Heather Shaw Bonilha
                Cited in Scopus: 46
                Online Extra
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                  Behavioral voice therapy guided by a speech-language pathologist is recommended as the main treatment approach for many kinds of voice disorders. Encouraging evidence regard of good outcomes from voice therapy has been found in two previous reviews on broad patient populations. However, no definitive conclusion on the effectiveness of direct voice therapy can be drawn from these reviews due to limitations of the included studies.
                  A Systematic Review of Voice Therapy: What “Effectiveness” Really Implies
                • Research Article

                  Real-time Simultaneous DKG and 2D DKG Using High-speed Digital Camera

                  Journal of Voice
                  Vol. 31Issue 2p247.e1–247.e7Published online: November 8, 2016
                  • Duck-Hoon Kang
                  • Soo-Geun Wang
                  • Hee-June Park
                  • Jin-Choon Lee
                  • Gye-Rok Jeon
                  • Ill-Sang Choi
                  • and others
                  Cited in Scopus: 10
                  Online Extra
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                  • Video
                  For the evaluation of voice disorders, direct observation of vocal cord vibration is important. Among the various methods, laryngeal videostroboscopy (LVS) is widely used, but it was not a true image because it collects images from different cycles. In contrast, high-speed videoendoscopy and videokymography have much higher frame rates and can assess functional and mobility disorders.
                  Real-time Simultaneous DKG and 2D DKG Using High-speed Digital Camera
                • Research Article

                  Evaluation of Vocal Fold Motion Abnormalities: Are We All Seeing the Same Thing?

                  Journal of Voice
                  Vol. 31Issue 1p72–77Published online: November 2, 2016
                  • Lyndsay L. Madden
                  • Clark A. Rosen
                  Cited in Scopus: 9
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                    Flexible laryngoscopy is the principle tool for the evaluation of vocal fold motion. As of yet, no consistent, unified outcome metric has been developed for vocal fold paralysis/immobility research. The goal of this study was to evaluate vocal fold motion assessment (inter- and intra-rater reliability) among general otolaryngologists and fellowship-trained laryngologists.
                    Evaluation of Vocal Fold Motion Abnormalities: Are We All Seeing the Same Thing?
                  • Research Article

                    Laboratory Evaluation of Vocal Fold Paralysis and Paresis

                    Journal of Voice
                    Vol. 31Issue 2p168–174Published online: November 1, 2016
                    • Michelle White
                    • Kirsten Meenan
                    • Tirth Patel
                    • Aaron Jaworek
                    • Robert T. Sataloff
                    Cited in Scopus: 9
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                      This study aimed to assess the value of comprehensive laboratory evaluation in patients with vocal fold paralysis or paresis.
                    • Research Article

                      Adverse Reaction to Hyaluronic Acid Injection Laryngoplasty: A Case Report

                      Journal of Voice
                      Vol. 31Issue 2p245.e1–245.e2Published online: November 1, 2016
                      • Henri Traboulsi
                      • Tamer El Natout
                      • Ghassan Skaff
                      • Abdul-Latif Hamdan
                      Cited in Scopus: 7
                      Online Extra
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                        Injection laryngoplasty using hyaluronic acid is a safe procedure commonly performed on patients with glottic insufficiency.
                        Adverse Reaction to Hyaluronic Acid Injection Laryngoplasty: A Case Report
                      • Research Article

                        Shape of Thyroid Cartilage Influences Outcome of Montgomery Medialization Thyroplasty: A Gender Issue

                        Journal of Voice
                        Vol. 31Issue 2p245.e3–245.e8Published online: October 18, 2016
                        • Gauthier Desuter
                        • Sylvie Henrard
                        • Julie T. Van Lith-Bijl
                        • Avigaëlle Amory
                        • Thierry Duprez
                        • Peter Paul van Benthem
                        • and others
                        Cited in Scopus: 10
                        Online Extra
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                          This study aimed to determine whether the shape of the thyroid cartilage and gender influence voice outcomes after a Montgomery thyroplasty implant system (MTIS).
                          Shape of Thyroid Cartilage Influences Outcome of Montgomery Medialization Thyroplasty: A Gender Issue
                        • Research Article

                          Optimized Nonlinear Dynamic Analysis of Pathologic Voices With Laryngeal Paralysis Based on the Minimum Embedding Dimension

                          Journal of Voice
                          Vol. 31Issue 2p249.e1–249.e7Published online: August 20, 2016
                          • Nanmu Huang
                          • Yu Zhang
                          • William Calawerts
                          • Jack J. Jiang
                          Cited in Scopus: 7
                          Online Extra
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                            The present study aims to compare the correlation dimension and second-order entropy at the minimum embedding dimension with the correlation dimension (D2) and second-order entropy (K2) based on their efficiency and accuracy in differentiating between normal and pathologic voices.
                            Optimized Nonlinear Dynamic Analysis of Pathologic Voices With Laryngeal Paralysis Based on the Minimum Embedding Dimension
                          • Research Article

                            Correlation of VHI-30 to Acoustic Measurements Across Three Common Voice Disorders

                            Journal of Voice
                            Vol. 31Issue 1p34–40Published online: April 13, 2016
                            • Ali Dehqan
                            • Fariba Yadegari
                            • Ronald C. Scherer
                            • Peyman Dabirmoghadam
                            Cited in Scopus: 25
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                              Voice disorders that affect the quality of voice also result in varying degrees of psychological and social problems. The research question here is whether the correlations between Voice Handicap Index (VHI)-30 scores and objective acoustic measures differ in patients with different types of voice disorders.
                            • Research Article

                              Laryngeal Electromyography for Prognosis of Vocal Fold Paralysis

                              Journal of Voice
                              Vol. 31Issue 1p90–93Published online: April 5, 2016
                              • Adriana Pardo-Maza
                              • Isabel García-Lopez
                              • Susana Santiago-Pérez
                              • Javier Gavilán
                              Cited in Scopus: 16
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                                This study aimed to determine the value of laryngeal electromyography in the prognosis of vocal fold paralysis.
                              • Research Article

                                Phasegram Analysis of Vocal Fold Vibration Documented With Laryngeal High-speed Video Endoscopy

                                Journal of Voice
                                Vol. 30Issue 6p771.e1–771.e15Published online: February 12, 2016
                                • Christian T. Herbst
                                • Jakob Unger
                                • Hanspeter Herzel
                                • Jan G. Švec
                                • Jörg Lohscheller
                                Cited in Scopus: 10
                                Online Extra
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                                In a recent publication, the phasegram, a bifurcation diagram over time, has been introduced as an intuitive visualization tool for assessing the vibratory states of oscillating systems. Here, this nonlinear dynamics approach is augmented with quantitative analysis parameters, and it is applied to clinical laryngeal high-speed video (HSV) endoscopic recordings of healthy and pathological phonations.
                                Phasegram Analysis of Vocal Fold Vibration Documented With Laryngeal High-speed Video Endoscopy
                              • Research Article

                                Clinical and Electromyographic Characteristics of Unilateral Vocal Fold Paralysis With Lower Cranial Nerve Injury

                                Journal of Voice
                                Vol. 31Issue 1p126.e1–126.e6Published online: February 1, 2016
                                • Rong Hu
                                • Yun Li
                                • Wen Xu
                                • Liyu Cheng
                                • Hui Ren
                                Cited in Scopus: 4
                                Online Extra
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                                  The aim was to investigate the clinical and electromyographic characteristics of patients with unilateral vocal fold paralysis (UVFP) combined with lower cranial nerve injury.
                                  Clinical and Electromyographic Characteristics of Unilateral Vocal Fold Paralysis With Lower Cranial Nerve Injury
                                • Research Article

                                  Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis

                                  Journal of Voice
                                  Vol. 30Issue 6p767.e9–767.e15Published online: December 3, 2015
                                  • Olivia Busto-Crespo
                                  • María Uzcanga-Lacabe
                                  • Ana Abad-Marco
                                  • Iosune Berasategui
                                  • Lola García
                                  • Enrique Maraví
                                  • and others
                                  Cited in Scopus: 22
                                  Online Extra
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                                    To investigate the long-term effectiveness of voice therapy in vocal outcomes of patients with unilateral vocal fold paralysis (UVFP) and vocal productions of patients with long-standing treatment-naïve UVFP treated with voice therapy.
                                    Longitudinal Voice Outcomes After Voice Therapy in Unilateral Vocal Fold Paralysis
                                  • Research Article

                                    Quantitative Analysis of Vocal Fold Vibration in Vocal Fold Paralysis With the Use of High-speed Digital Imaging

                                    Journal of Voice
                                    Vol. 30Issue 6p766.e13–766.e22Published online: December 1, 2015
                                    • Akihito Yamauchi
                                    • Hisayuki Yokonishi
                                    • Hiroshi Imagawa
                                    • Ken-Ichi Sakakibara
                                    • Takaharu Nito
                                    • Niro Tayama
                                    Cited in Scopus: 13
                                    Online Extra
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                                      The goal of this work was to objectively elucidate the vibratory characteristics of vocal fold paralysis (VFP) using high-speed digital imaging (HSDI).
                                      Quantitative Analysis of Vocal Fold Vibration in Vocal Fold Paralysis With the Use of High-speed Digital Imaging
                                    • Research Article

                                      Air Pressure and Contact Quotient Measures During Different Semioccluded Postures in Subjects With Different Voice Conditions

                                      Journal of Voice
                                      Vol. 30Issue 6p759.e1–759.e10Published online: October 29, 2015
                                      • Marco Guzmán
                                      • Christian Castro
                                      • Sofia Madrid
                                      • Christian Olavarria
                                      • Miguel Leiva
                                      • Daniel Muñoz
                                      • and others
                                      Cited in Scopus: 64
                                      Online Extra
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                                        The purpose of this study was to investigate the effect of phonation into tubes in air and tubes submerged in water on air pressure variables and vocal fold adduction in subjects with different voice conditions.
                                        Air Pressure and Contact Quotient Measures During Different Semioccluded Postures in Subjects With Different Voice Conditions
                                      • Research Article

                                        Analysis and Classification of Voice Pathologies Using Glottal Signal Parameters

                                        Journal of Voice
                                        Vol. 30Issue 5p549–556Published online: October 13, 2015
                                        • Leonardo A. Forero M.
                                        • Manoela Kohler
                                        • Marley M.B.R. Vellasco
                                        • Edson Cataldo
                                        Cited in Scopus: 31
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                                          The classification of voice diseases has many applications in health, in diseases treatment, and in the design of new medical equipment for helping doctors in diagnosing pathologies related to the voice. This work uses the parameters of the glottal signal to help the identification of two types of voice disorders related to the pathologies of the vocal folds: nodule and unilateral paralysis. The parameters of the glottal signal are obtained through a known inverse filtering method, and they are used as inputs to an Artificial Neural Network, a Support Vector Machine, and also to a Hidden Markov Model, to obtain the classification, and to compare the results, of the voice signals into three different groups: speakers with nodule in the vocal folds; speakers with unilateral paralysis of the vocal folds; and speakers with normal voices, that is, without nodule or unilateral paralysis present in the vocal folds.
                                          Analysis and Classification of Voice Pathologies Using Glottal Signal Parameters
                                        • Research Article

                                          Interrater Reliability in Analysis of Laryngoscopic Features for Unilateral Vocal Fold Paresis

                                          Journal of Voice
                                          Vol. 30Issue 6p736–740Published online: October 12, 2015
                                          • Tova F. Isseroff
                                          • Arjun K. Parasher
                                          • Amanda Richards
                                          • Mark Sivak
                                          • Peak Woo
                                          Cited in Scopus: 11
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                                            The diagnosis of paresis in patients with vocal fold motion impairment remains a challenge. In particular, laryngoscopy examination may result in significant disagreement in diagnosis among providers. We hypothesize that systematically evaluating for a standard set of clinical parameters will increase the diagnostic concordance among providers.
                                            Interrater Reliability in Analysis of Laryngoscopic Features for Unilateral Vocal Fold Paresis
                                          • Research Article

                                            Features of Vocal Fold Adductor Paralysis and the Management of Posterior Muscle in Thyroplasty

                                            Journal of Voice
                                            Vol. 30Issue 2p234–241Published online: July 13, 2015
                                            • Ujimoto Konomi
                                            • Ryoji Tokashiki
                                            • Hiroyuki Hiramatsu
                                            • Ray Motohashi
                                            • Eriko Sakurai
                                            • Fumimasa Toyomura
                                            • and others
                                            Cited in Scopus: 5
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                                              To present the pathologic characteristics of unilateral recurrent nerve adductor branch paralysis (AdBP), and to investigate the management of posterior cricoarytenoid (PCA) muscle on the basis of our experience of surgical treatment for AdBP.
                                              Features of Vocal Fold Adductor Paralysis and the Management of Posterior Muscle in Thyroplasty
                                            • Research Article

                                              Quantitative Analysis of the Visor-Like Vertical Motion of the Cricoarytenoid Joint in the Living Subject

                                              Journal of Voice
                                              Vol. 30Issue 3p354–361Published online: June 3, 2015
                                              • Qin Wang
                                              • Liang Liang
                                              • Yehai Liu
                                              • Ming Zhang
                                              Cited in Scopus: 3
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                                                The cricoarytenoid joint has a loose capsule and large cavity and may allow the arytenoid distanced from the cricoid cartilage. The objective was to quantify vertical motion of the arytenoid cartilage in the living subject.
                                                Quantitative Analysis of the Visor-Like Vertical Motion of the Cricoarytenoid Joint in the Living Subject
                                              • Research Article

                                                Sex Differences in Pitch Range and Speech Fundamental Frequency After Arytenoid Adduction and Thyroplasty

                                                Journal of Voice
                                                Vol. 30Issue 3p362–370Published online: May 18, 2015
                                                • Ujimoto Konomi
                                                • Yusuke Watanabe
                                                • Daigo Komazawa
                                                Cited in Scopus: 6
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                                                  The purpose of this study was to clarify the sex differences in pitch range (PR) and speech fundamental frequency (SFF) after arytenoid adduction (AA) combined with type 1 thyroplasty (TP1) in patients with unilateral vocal fold paralysis (UVFP) and to assess the cause of these differences.
                                                  Sex Differences in Pitch Range and Speech Fundamental Frequency After Arytenoid Adduction and Thyroplasty
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