Abstract
We have developed a novel surgical/computational model for the investigation of unilateral vocal fold paralysis (UVFP) which will be used to inform future in silico approaches to improve surgical outcomes in type I thyroplasty. Healthy phonation (HP) was achieved using cricothyroid suture approximation on both sides of the larynx to generate symmetrical vocal fold closure. Following high-speed videoendoscopy (HSV) capture, sutures on the right side of the larynx were removed, partially releasing tension unilaterally and generating asymmetric vocal fold closure characteristic of UVFP (sUVFP condition). HSV revealed symmetric vibration in HP, while in sUVFP the sutured side demonstrated a higher frequency (10 - 11%). For the computational model, ex vivo magnetic resonance imaging (MRI) scans were captured at three configurations: non-approximated (NA), HP, and sUVFP. A finite-element method (FEM) model was built, in which cartilage displacements from the MRI images were used to prescribe the adduction and the vocal fold deformation was simulated before the eigenmode calculation. The results showed that the frequency comparison between the two sides were consistent with observations from HSV. This alignment between the surgical and computational models supports the future application of these methods for the investigation of treatment for UVFP.
Highlights
The vocal folds are a pair of highly specialized tissues housed in the larynx, which when adducted into glottal controlled airflow, vibrate to produce voice
Unilateral vocal fold paralysis (UVFP) is a voice disorder caused by injury of the recurrent laryngeal nerve or vagus nerve innervating the larynx [3], resulting in impaired adduction, one-sided vocal fold immobility, and a widened glottal gap
We describe a method to investigate vocal fold approximation in normal phonation and simulated UVFP conditions experimentally and numerically
Summary
The vocal folds are a pair of highly specialized tissues housed in the larynx, which when adducted into glottal controlled airflow, vibrate to produce voice. Disordered vocal folds lead to many impairments, including poor voice quality, swallowing dysfunction, breathlessness, and aspiration [2]. Unilateral vocal fold paralysis (UVFP) is a voice disorder caused by injury of the recurrent laryngeal nerve or vagus nerve innervating the larynx [3], resulting in impaired adduction, one-sided vocal fold immobility, and a widened glottal gap. The symptomatic burden of UVFP on patients is significant with 53–100% of identified cases experiencing dysphonia [6,7,8], 60–75% dyspnea [9,10], and approximately 60% dysphagia [6], resulting in an increased risk of aspiration [11]
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