The treatment of bilateral immobile vocal cords (BAP) is a balance between phonation, airway and swallowing. Various techniques of endoscopic approach for the treatment of bilateral vocal fold immobility have been proposed and have been modified by various surgeons. Trans oral CO ₂ laser endoscopic arytenoidectomy has become the most common method for its management. CO ₂ laser is arguably the most appropriate tool for cordectomy with the advantage of increased precision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using trans oral CO ₂ laser for management of BAP. The present modality of preservation of part of shelf of arytenoid and use of laser in super pulse mode contribute to good results with minimum complication

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Background: Knowledge of the size and proportions of the human larynx is essential for the diagnosis and treatment of laryngeal disorders. Objective of the present cadaveric study was to study dimensions of larynx, various laryngeal folds and laryngeal cavity of adult human larynx in the western Indian population. Materials and Methods: Sagittal section of the head and neck region was taken from the cadaver. Larynx was separated from tongue from the level of hyoid bone to 3 ^rd tracheal ring. The measurements of intact and split larynx were taken with the help of digital vernier caliper, thread, and scale. Data was analyzed using software StatistiXL. For each of the parameters, the mean, standard deviation (S.D.), and range was calculated. Z test was used to test the significance of difference between the two mean. Results: Height of larynx from floor of thyroid notch to lower margin of cricoid cartilage was 32.42 ± 3.41 mm. Height of larynx from upper border of hyoid to lower border of cricoid. (L2) was 54.39 ± 6.04 mm. Height of larynx from tip of epiglottis to lower margin of cricoid cartilage was 57.13 ± 7.32 mm. Total height of laryngeal cavity was 61.51 ± 6.84 mm. Bilateral symmetry was noted in the size of vocal and vestibular folds length. Conclusion: There was wide individual variation in the dimensions of the most of the parameters in the selected population. Bilateral asymmetry, though present in majority of specimens, was insignificant. Morphometrical data of the larynx may be very useful in otorhinolaryngology, laryngeal microsurgery, and evaluation of results of diagnostic techniques. These parameters can be helpful in evaluation of the damage and proper repair of the larynx.

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Various materials such as autogenous cartilage, silicone, hydroxylapatite, Gore-tex (expanded polytetrafluoroethylene), and titanium have been used for medialization laryngoplasty. We report an extrusion of Gore-tex implant after 11 months of medialization laryngoplasty. We believe tha t thought Gore-tex is a safe and easy-to-use implant for medialization laryngoplasty, the possibility of extrusion after the operation must not be ignored.

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A laryngeal granuloma (LG) is a benign tumor that usually develops on the cartilaginous vocal process of the vocal cords. Gastroesophageal reflux (GER), hyperfunctional use of the voice, and intubation injury are etiological factors. Patients usually complain of dysphagia, and dysphonia. A 53-year-old male consulted the Taksim Educational and Research Hospital ENT Department, complaining of a 6-month history of hoarseness, dysphagia, and globus sensation. On laryngoscopic examination, a granuloma was found on his left vocal process He was given an anti reflux treatments and advised on vocal hygiene. At the 1-month follow-up, the granuloma had disappeared. A thorough history was taken and disclosed that at time of his first visit, he saw a gastroenterologist for his heartburn and regurgitation and was administered pantoprazole 40 mg once daily. Consequently, the rapid resolution of the granuloma was thought have resulted from the high-dose double PPI treatment.

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Neuroendocrine tumors of the larynx are rare, comprising only about 0.5% of laryngeal tumors. These tumors are characterized by pathological and biological heterogeneity. Well differentiated carcinoid tumor is the rarest variety of laryngeal neuroendocrine neoplasms. This tumor most commonly appears as a submucosal lesion of the supraglottic larynx. As per our knowledge, this tumor has never been reported in the subglottis. In this article we describe a rare case of a well-differentiated carcinoid tumor of the larynx involving the subglottis.

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Background: Substances available for vocal cord augmentation procedure have their own advantages and limitations. Autologous fat is accepted to be one of the safest substance for augmentation. Objective: To evaluate the subjective and objective changes in vocal outcome following fat augmentation surgery for phonatory gaps. Materials and Methods: 30 patients with phonatory gap <2 mm were included in this prospective study. These consisted of sulcus vocalis (14), vocal cord atrophy (05) and vocal cord palsy (11). Per-operatively harvested umbilical fat was used for augmentation after mincing it and removing all the connective tissue. Follow-up of patients was done at 1, 3 and 6 months interval. Pre- and postoperative videostroboscopy was done. Objective analysis of voice was done using maximum phonatory time (MPT) and noise to harmonic ratio (NHR). Subjective assessment of voice was done using the voice handicap index (VHI) and subjective change in quality of voice as assessed by the patient. Results: Patients with early stage sulcus, vocal atrophy and vocal cord palsy, with small vocal gap, showed significantly good results after fat augmentation; however, results of patients with sulcus vocalis of grade II and III were not very satisfactory.

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Microlaryngeal tracheal (MLT) tube, when inserted through nasal route, offers adequate space in front of the tube for proper vision, excision and hemostasis of vocal cord lesions in the anterior and middle third portions as compared to oral route. There is less risk of kinking of tube at the point of securing with skin and it provides easy instrumentation for exposure of oral cavity. MLT tube placed nasally lies in the posterior comissure of vocal cord between arytenoids, leaving anterior two-third or more unobscured.

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