2017-18 HSC Section 3 Green Book

J.E.

Strychowsky

et

al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

959–964

Fig. 4. Endoscopic

repair of

right

true vocal

fold avulsion

[*5-0 vicryl

suture prior

to

trimming].

Fig.

2.

Right

true

vocal

fold

avulsion

appearance with

0-degree

endoscope.

the

right

true membranous VF approximately half-way

in between

( Figs. 2 and 3 ). The right

the anterior commissure and vocal process

fold, FVFs, and both arytenoids were edematous with

aryepiglottic

small

hematoma

of

the

FVF.

The

cricoarytenoid

joints

were

a

mobile. There was evidence of a mucosal tear just

lateral

to the FVF,

into

the

paraglottic

space with

some

exposure

of

the the

extending

cortex

of

the

right

thyroid

lamina.

Palpation

along

inner

revealed

some air

external neck during direct airway visualization

escaping

from

this

area.

The

subglottis

and

distal

airway

bubbles

normal

in

appearance.

Rigid

esophagoscopy was

normal.

were

Fig.

5.

Two

days

after

endoscopic

repair

of

right

true

vocal

fold

avulsion.

suspension was

used

to

allow

for

a more

thorough right TVF tear. The

Laryngeal

the

injury. Microscopic

inspection of

the

examination of

the

suspected avulsion and

laryngeal mucosal

confirmed

the VF

appeared

to be

anchored displaced

to

the anterior

anterior portion of

The

posterior

portion

was

inferiorly

but was free

commissure.

anchored

to

the

vocal

process.

An

endoscopic

repair

still

two 5-0 vicryl sutures

to approximate

the

two

performed with

the VF

( Fig. 4 ). The

torn mucosa was draped over a portion

ends of

left to heal by secondary

intention. The

of the exposed cartilage and

intubated with

a 4.5

cuffed

endotracheal

tube

so

that

patient was

limited over

the

subsequent 2 days

to

any VF movement would be

time healing. Forty-eight hours after for

allow

endoscopic

repair, he was brought back

the operating

room

for evaluation and extubation. The

repair of

to

avulsed

right

TVF

was

intact;

there

was

a

small

amount

of

the

nonobstructive granulation the TVF and along both arytenoids posteriorly ( Fig. 5 ). The small area of exposed cartilage was still visible. A tract of granulation tissue along the posterior cricoid was also noted. tissue along the anterior portion of

Fig.

6.

Flexible

fiberoptic

laryngoscopy

7

months

after

injury

and

repair.

swallow

study

on

the

day

following

extubation was

normal

A

from hospital 6 days

later on a 7-day course

and he was discharged

oral

antibiotics

and

antireflux

medication

to

continue

until

of

follow-up.

Some

granulation

tissue

at

the

posterior

outpatient

follow-up visit. He was

started

right TVF was noted at his 2-month

inhaled

corticosteroids. He

is

now

7 months

since

injury; scarring

his

on

returned

to normal. Although

there

is minor

at

voice has

repair

site,

there

is

normal movement

of

his

vocal

folds

on

the

fiberoptic

examination with

resolution

of

the

previously

flexible

granulation

tissue

on

the

TVF

( Fig.

6 ).

seen

Fig.

3.

Right

true

vocal

fold

avulsion

appearance with

0-degree

endoscope.

37