A 44-year-old male known case of bilateral optic nerve sheathmeningiomas treated by radiation therapy presented to thevoice unit with progressive change in voice quality. Flexiblelaryngoscopy showed left vocal cord paresis with incompleteclosure of the vocal folds during phonation. Computerizedtomography of the neck and chest was normal, and neuromusculartesting that included peripheral nerve conduction did notreveal any primary neuromuscular disease. Workup includingcerebrospinal fluid studies for cytomegalovirus, Epstein-Barrvirus, culture, cytology, Mycobacterium tuberculosis, and oligoclonalband was negative. Laryngeal electromyography ofbilateral thyroarytenoid and cricothyroid muscles showed mildchronic neurogenic changes on the left side, suggestive ofinjury to the left recurrent laryngeal and external superior laryngealnerves. The patient elected conservative measures withclose observation. Follow-up 2 years later showed worseningof his dysphonia with shortness of breath. On laryngeal examination,there was complete fixation of the left vocal fold withmild paresis of the right vocal fold. Neurologic examinationalso showed evidence of moderate right hypoglossal nervepalsy. The patient underwent injection laryngoplasty of the leftvocal fold using 0.5 mL of cross-linked hyaluronic acid (RestylaneQ-Med AB, Uppsala, Sweden). The transanal fiberopticapproach was used for the application of laryngeal anesthesia(laryngeal gargle) and for the injection (Figure 1). The patienttolerated the procedure well and had marked improvement inhis voice quality.
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