The distended ventricle as a sign of bilateral abductor paralysis

Abstract

uk. Stridor can prove to be challenging to the attending physician. Assessing and securing the obstructed airway is of paramount importance but is confidently undertaken only after an initial tentative diagnosis of the cause of stridor. Direct evaluation of the larynx by indirect laryngoscopy and fibreoptic laryngoscopy is the most informative examination— but may not be feasible (e.g., pediatric patients) and may not be available in the emergency situation. Sophisticated imaging, too, is often impossible due to movement artifact and the inadvisability of taking a stridulous patient to the scanner room. In many situations, the only evaluation that is immediately possible is radiography of the soft tissues of the neck. The usefulness of radiographs is currently restricted to indicating the diagnosis in cases of epiglottitis, croup, and foreign bodies of the laryngopharynx. This report describes an additional sign, the “distended ventricle” sign, which has been found useful in cases with bilateral vocal fold paralysis. Prior to the advent of computerized sectional imaging, the technique of visualizing the laryngeal ventricle was by sectional tomograms and by contrast laryngography. Assessment of the laryngeal ventricle was considered vital in the evaluation of cases of early laryngeal cancer with regard to their suitability for a partial laryngectomy. The specific maneuver to dilate the laryngeal ventricle and facilitate its imaging was by asking the patient to simulate “inspiratory phonation,” or to vocalize a “reverse E.” Since the stridor secondary to bilateral vocal fold paralysis (bilateral abductor paralysis) is indeed no different from “inspiratory phonation” or from voicing a “reverse E,” it is logical to assume that it would result in a dilated laryngeal ventricle. The soft tissue neck radiograph is routinely taken in inspiration and