[Pseudoglottis after laryngeal trauma with bilateral recurrent laryngeal nerve paralysis]

Voice is produced by a steady flow of air from the lungs, which is segmented at the laryngeal level into a series of air puffs. The segmentation is facilitated by periodic vocal fold vibrations under physiological conditions. In some cases, as in partial laryngectomy, segmentation of air stream is caused by vibrations of the false vocal folds. Here we report a case of an air stream segmentation mechanism at the laryngeal level producing an acceptable voice quality after fracture of the larynx and bilateral vocal fold paralysis. A lateral fixation of the left vocal fold was performed because of dyspnea. Six years later the patient was reexamined, at which time he had fairly intelligible speech and did not complain about dyspnea or aspiration. The voicing source was found to be a round soft tissue lump of approximately 1.5 cm diameter. This tissue was formed from the former left arytenoid area. During phonation the right arytenoid cartilage approximated to the petiolus, while the left neoarytenoid closed the residual opening of the larynx. However, during voicing, this latter tissue exhibited a vertical vibratory pattern similar to false vocal fold vibration and mucosal vibration of true vocal folds at high pitch. It seems reasonable to speculate that the mass of the tissue lump had become well balanced so that the very low pitch of the false vocal fold and a high pitch as in head register phonation could be avoided. Since the patient suffered from a pronounced gag reflex during examination, stroboscopy was videorecorded and analyzed off-line.(ABSTRACT TRUNCATED AT 250 WORDS)