Vocal process avulsion

Left Vocal Process Avulsion

Vocal fold process avulsion results from trauma that detaches the vocal process and thyroarytenoid muscle from the body of the arytenoid cartilage. Vocal fold laxity often causes severe dysphonia. Findings can be subtle. A high index of suspicion often permits diagnosis and effective surgical repair.

Thyroarytenoid Muscle Avulsion

Thyroarytenoid muscle avulsion is a rare condition in which laryngeal trauma causes a separation of the thyroarytenoid muscle from the arytenoid cartilage. Typically, symptoms are nonspecific but include severe dysphonia and voice fatigue. They are similar to symptoms of vocal process avulsion. Strobovideolaryngoscopy, laryngeal electromyography, and laryngeal computed tomography may be helpful in diagnosis. However, intraoperative palpation under general anesthesia is the most definitive way to establish its diagnosis. We present two cases of thyroarytenoid muscle avulsion, a condition that has not been described previously. Surgical techniques for repair are detailed.

The Laryngology Hospitalist

The traditional pattern of medical practice is a combination of outpatient and inpatient care. There has been a recent trend for many specialties to separate this care, concentrating on only one of these spheres. A clinician caring only for inpatients is a Hospitalist. The care pattern for airway and swallowing disease adopted at the University of Maryland Hospital is in the form of the laryngology hospitalist. This new surgical specialty is a hybrid of an airway surgery subspecialist and a pure hospitalist. It offers an array of advantages to patients and colleague clinicians. One advantage is that of ubiquitous availability, which offers obvious safety benefits to patients with airway patency problems. Other advantages include the potential for consistent in-depth collaboration with other clinicians such as emergency room physicians, intensivists, neurologists/neurosurgeons, pulmonologists, gastroenterologists, speech and language pathologists, and radiologists. Financial benefits to the clinician include a more favorable ratio of operative disease versus total patient contacts. Benefits to third-party payers include the more efficient and timely delivery of care in the context of an inpatient stay.