Cause Of Paralysis Research Articles

Acupuncture therapy to the head and face to treat post-trauma paralysis of peripheral fascial nerve dextra

Damage to the facial nerve due to trauma from traffic accidents is the second most common cause of paralysis of the facial nerve. The treatments include both pharmacological and non-pharmacological therapy. Acupuncture is a method of treatment that applies evidence-based medical principles and uses anatomy, physiology, and pathology to place needles atcertain acupuncture points. This paper describes a 26-year-old female patient with right-side facial palsy following a traffic accident who had animproved Brackmann’s score after 12 sessions of acupuncture treatment. The acupuncture points were chosen based on Liu Yan’sbrain-clearing needling technique. Acupuncture can shorten healing time and improve the effect of treatment for facial-nerve paralysis.

Ferulic Acid Improves Functional Recovery after Acute Spinal Cord Injury in Rats by Inducing Hypoxia to Inhibit microRNA-590 and Elevate Vascular Endothelial Growth Factor Expressions.

Spinal cord injury (SCI) is the leading cause of paralysis, disability and even death in severe cases, and neural stem cells (NSCs) transplant has been employed for repairing SCI. Ferulic acid (FA) is able to promote neurogenesis in various stem cell therapies. We aimed to investigate the effect of FA on NSC transplant therapy, and the underlying mechanism, in improving functional recovery in SCI rat model. A rat model of SCI was established, which then received transplant of NSCs with or without FA pre-treatment. Functional recovery of the SCI rats was then evaluated, in terms of spinal cord water content, myeloperoxidase activity and behavioral assessments. Effect of FA in inducing hypoxia in NSCs was also assessed, followed by identifying the hypoxic regulated microRNA and the subsequent target gene. Transplant of FA pre-treated NSCs improved functional recovery of SCI rats to a more significant extent than NSCs without FA pre-treatment. The beneficial effects of FA in repairing SCI was mediated by inducing hypoxia in NSCs, which in turn inhibited microRNA-590 to elevate vascular endothelial growth factor expression. Our findings support the clinical potential of FA in improving efficacy of NSC transplant therapy for treatment of SCI.

Resistance categories to Acanthoscelides obtectus (Coleoptera: Bruchidae) in tepary bean (Phaseolus acutifolius), new sources of resistance for dry bean (Phaseolus vulgaris) breeding

Acanthoscelides obtectus (Coleoptera: Bruchidae) is one of the most important post-harvest pests of dry bean Phaseolus vulgaris L. Tepary bean (Phaseolus acutifolius) could be a novel source of resistance against A. obtectus to improve dry bean. We studied the resistance of tepary bean varieties to A. obtectus. We focused on three categories of defense: antixenosis, antibiosis, and tolerance. Tepary pinto amarillo (T-amarillo) and Tepary pinto negro (T-negro) beans show high antixenosis to adults, increased numbers paralyzed per hour and per day, and increased duration of development in winter; reduced oviposition, number of emerged adults and adult weight. Due to the small number of emerged adults, there was very little grain weight loss. Volatile compounds were discarded as the cause of paralysis in adults. Adults in T-amarillo and T-negro were paralyzed until day 10 and 14 and then, they die at an exponentially increasing rate. In addition T-negro and T-amarillo produced the highest mortality in larvae before entering the seeds. T-amarillo and T-negro showed antixenoxis, resistance and tolerance to A. obtectus infestation and they can be used as sources of resistance for P. vulgaris breeding. The compound that causes the antixenosis and paralysis in adults is in the testa of the resistant varieties and is not likely to be a volatile compound, whereas the mortality and antixenosis in larvae is caused more probably by a volatile compound present in the testa.

ベジタリアンに発症した両側声帯麻痺の1例

Vocal cord paralysis often occurs due to unknown reasons. Since bilateral paralysis can cause dyspnea,we have to carefully watch the state of the patient while investigating the causes of paralysis. We herein report a case of bilateral vocal cord paralysis in a patient who was a vegetarian. The patient’ paralysis was improved by the administration of mecobalamin.

Zika Virus and Guillain-Barre Syndrome: Is There Sufficient Evidence for Causality?

Worldwide concern over Zika virus causing Guillain–Barre syndrome (GBS) soared after recent reports that Zika-related weakness was due to GBS. A global strategic response plan was initiated with recommendations for at-risk countries to prepare for GBS. This plan has major economic implications, as nations with limited resources struggle to implement costly immunotherapy. Since confirmation of causality is prerequisite to providing specific management recommendations, it is prudent to review data endorsing a GBS diagnosis. We searched PubMed for manuscripts reporting original clinical, laboratory, and electrodiagnostic data on Zika virus and GBS. Five papers met criteria; four case reports and one large case–control study (French Polynesia) that attributed 42 paralysis cases to a motor variant of GBS. Brighton criteria were reportedly used to diagnose GBS, but no differential diagnosis was presented, which violates criteria. GBS was characterized by early onset (median 6 days post-viral syndrome), rapid progression (median 6 days from onset to nadir), and atypical clinical features (52% lacked areflexia, 48% of facial palsies were unilateral). Electrodiagnostic evaluations fell short of guidelines endorsed by American Academy of Neurology. Typical anti-ganglioside antibodies in GBS motor variants were rarely present. We conclude that there is no causal relationship between Zika virus and GBS because data failed to confirm GBS and exclude other causes of paralysis. Focus should be redirected at differential diagnosis, proper use of diagnostic criteria, and electrodiagnosis that follows recommended guidelines. We also call for a moratorium on recommendations for at-risk countries to prepare costly immunotherapies directed at GBS.

Prevalence and Causes of Paralysis—United States, 2013

To estimate the prevalence and causes of functional paralysis in the United States. We used the 2013 US Paralysis Prevalence & Health Disparities Survey to estimate the prevalence of paralysis, its causes, associated sociodemographic characteristics, and health effects among this population. Nearly 5.4 million persons live with paralysis. Most persons with paralysis were younger than 65 years (72.1%), female (51.7%), White (71.4%), high school graduates (64.8%), married or living with a partner (47.4%), and unable to work (41.8%). Stroke is the leading cause of paralysis, affecting 33.7% of the population with paralysis, followed by spinal cord injury (27.3%), multiple sclerosis (18.6%), and cerebral palsy (8.3%). According to the functional definition, persons living with paralysis represent a large segment of the US population, and two thirds of them are between ages 18 and 64 years. Targeted health promotion that uses inclusion strategies to account for functional limitations related to paralysis can be undertaken in partnership with state and local health departments.

Traumatic and Nontraumatic Facial Nerve Disorder

Background: The facial nerve has the longest intraosseous paths of the cranial nerves. There is controversy regarding the surgical approaches and time of surgery to obtain the best outcome after facial nerve surgery. Different surgical approaches depending on severity and location of injury, hearing status, and surgeon skills have been used in facial nerve disorders. Whenever the continuity of the facial nerve has been disrupted, we should restore its continuity. In some instances, an end-to-end reapproximation can be accomplished, but if any tension occurs at the anastomotic site, interposition nerve grafts confer a better chance of allowing facial movement. Patients: In this cross-sectional study, 16 patients with facial paralysis were evaluated and followed up for at least 12 month and at most 36 month. Patients according to cause of paralysis were divided into 4 groups: traumatic (10 cases), iatrogenic (2 cases), chronic middle ear infection (2 cases), and idiopathic (2 cases). All of them were suffering from complete facial paralysis (grade VI). Surgery was performed on those who demonstrated either >90% fiber degeneration in ENOG within 3 weeks of injury or passing >4 to 6 months since the start of paralysis in the absence of regeneration. Finally, 12 decompression only, 1 decompression and end-to-end anastomosis, and 3 decompression and facial nerve grafting were accomplished. Conclusions: Results were good to satisfactory (I-II/VI) in 12 cases, acceptable (III-IV/VI) in 2 cases, and no recovery was observed in 2 cases.

An epidemiological analysis of acute flaccid paralysis in Khuzestan Province, southwest Iran, from 2006 to 2010.

OBJECTIVES:Investigations into the epidemiology of acute flaccid paralysis (AFP) are an essential strategic component of the Global Poliomyelitis Eradication Initiative of the World Health Organization (WHO), and are part of the certification process for polio eradication worldwide. This is an epidemiological report of AFP incidence in children less than 15 years old in southwest Iran.METHODS:This was a retrospective cohort study, carried out based on WHO guidelines, in which we reviewed non-polio AFP cases recorded from January 2006 to December 2010 in different regions of Khuzestan Province, southwest Iran. In this study, the records of all children under 15 years old with AFP were evaluated.RESULTS:During a 5-year period, 137 cases of AFP were reported (incidence rate, 2.21 per 100,000 children <15 years old). More than 50% (73 of 137) of the cases were boys, and 52.6% (72 of 137) were under 5 years of age, with a mean age of 5.39±3.98 years. The incidence of AFP was significantly higher in older children (p=0.001). The most common cause of paralysis was Guillain-Barré syndrome (117 of 137). None of the cases were diagnosed with acute poliomyelitis.CONCLUSIONS:In this study, we found that the incidence rate of AFP in the region was almost in agreement with the expected incidence of AFP in children less than 15 years old; therefore, the AFP surveillance program in Khuzestan Province is satisfactory in terms of reliability and effectiveness. Nevertheless, routine vaccination against polio and ensuring that patients with AFP receive follow-up are essential for eradicating polio.

Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis

Scientific advances are increasing the options for improved upper limb function in people with cervical level spinal cord injury (SCI). Some of these interventions rely on identifying an aspect of paralysis that is not uniformly assessed in SCI: the integrity of the lower motor neuron (LMN). SCI can damage both the upper motor neuron and LMN causing muscle paralysis. Differentiation between these causes of paralysis is not typically believed to be important during SCI rehabilitation because, regardless of the cause, the muscles are no longer under voluntary control by the patient. Emerging treatments designed to restore upper extremity function (eg, rescue microsurgical nerve transfers, motor learning-based interventions, functional electrical stimulation) all require knowledge of LMN status. The LMN is easily evaluated using surface electrical stimulation and does not add significant time to the standard clinical assessment of SCI. This noninvasive evaluation yields information that contributes to the development of a lifetime upper extremity care plan for maximizing function and quality of life. Given the relative simplicity of this assessment and the far-reaching implications for treatment and function, we propose that this assessment should be adopted as standard practice for acute cervical SCI.

The Impact of AB5 Toxin Binding on Ganglioside Mimicry in Campylobacter jejuni Lipooligosaccharides

Campylobacter jejuni is an important pathogen in the developed world, causing more cases of acute gastroenteritis than any other bacteria. C. jejuni is also the leading cause of paralysis in the world, causing Guillain‐Barré syndrome in humans by mimicry of nerve gangliosides with its surface exposed lipooligosaccharides (LOS). In some cases this mimicry elicits a breakdown in immune tolerance and results in self‐reactive antibodies which damage the nerve cells. Interestingly, the commonly mimicked GM1 ganglioside is also the main receptor for cholera toxin (CT) from Vibrio cholerae as well as heat‐labile enterotoxin (LT) from Escherichia coli. We have shown that these two toxins bind C. jejuni strains that mimic GM1 ganglioside and clear bacterial growth. The binding and clearing phenotypes were observed closely using transmission and scanning electron microscopy. C. jejuni 11168 shows natural variation in its ability to mimic GM1 gangliosides. Due to phase‐variation in cgtB encoding the galactosyltransferase, this strain exists as a mixture cells with and without GM1 mimics. It was unclear why the strain retained this variation, given that mimicry of host gangliosides lends a significant fitness advantage by camouflaging the bacterium from host immune defenses. Therefore, LOS was isolated from 11168 exposed to CT and LT toxin and compared to the unexposed by silver staining and far Western blotting. These experiments revealed the loss of a band from toxin exposed LOS and a marked decrease in the ability to bind toxin. Furthermore, when genomic DNA was isolated from these two groups and the cgtB gene was sequenced, the variation that existed in the unexposed group was no longer observed in the presence of the toxins. This led to the hypothesis that C. jejuni 11168 may retain variation in the cgtB gene in order to avoid negative effects upon contact with these toxins in the host or the environment. In addition, when we used a strain of E. coli engineered to display the GM1 mimic on its surface, no clearance was observed suggesting that this interaction is pathogen specific. Our study identifies a new interaction between C. jejuni and the AB5 toxins that has not been previously described and provides a possible new relationship within the intestinal microbiome.Support or Funding InformationFunding provided by the Natural Sciences and Engineering Research Council of Canada, Alberta Innovates Technology Futures and Alberta Innovates Health Solutions.

Device Operated Aid for Patients using Head Movement

Background: Patients who are bed-ridden or paralyzed from neck down often rely on human assistance for their daily basic needs. Their life is a struggle even to do simple every day task. Now a days there are many assisted devices in making them do their daily task a simpler one. Methods: Famous scientist and physicist Stephen hawking who suffers from a rare paralysis disease uses a speech generating device to communicate. The main causes of paralysis are myopathy a diseases that affects the muscles, neuropathy they are caused by damages in the nerve, spinal cord injury or strokes in the brain the events that follow after this can be severe. In some cases paralysis can be permanent. Patients with paralysis have to often call out for help for switching on the light, fan or any other electronic devices. There must be a standee near to them every time. Findings: This paper aims in helping the bed-ridden patients to control the electrical appliances and basic switching on and off of lights, fans etc. without the help of by standee. The patient can totally depend upon him or herself. With the movement of head, patients can control fan, light and basic electronic devices. Improvements: This device works on the principle of an accelerometer which helps in detecting the head motion. A buzzer is also present in the device which helps the bedridden patients to call out for a human assistance. The device is tied to the patient’s neck. Moving the head towards left or right and up or down can switch on and off light, fan etc.

Purinergic Receptors in Spinal Cord-Derived Ependymal Stem/Progenitor Cells and Their Potential Role in Cell-Based Therapy for Spinal Cord Injury.

Spinal cord injury (SCI) is a major cause of paralysis with no current therapies. Following SCI, large amounts of ATP and other nucleotides are released by the traumatized tissue leading to the activation of purinergic receptors that, in coordination with growth factors, induce lesion remodeling and repair. We found that adult mammalian ependymal spinal cord-derived stem/progenitor cells (epSPCs) are capable of responding to ATP and other nucleotidic compounds, mainly through the activation of the ionotropic P2X4, P2X7, and the metabotropic P2Y1 and P2Y4 purinergic receptors. A comparative study between epSPCs from healthy rats versus epSPCis, obtained after SCI, shows a downregulation of P2Y1 receptor together with an upregulation of P2Y4 receptor in epSPCis. Moreover, spinal cord after severe traumatic contusion shows early and persistent increases in the expression of P2X4 and P2X7 receptors around the injury, which are completely reversed when epSPCis were ectopically transplanted. Since epSPCi transplantation significantly rescues neurological function after SCI in parallel to inhibition of the induced P2 ionotropic receptors, a potential avenue is open for therapeutic alternatives in SCI treatments based on purinergic receptors and the endogenous reparative modulation.

Masseteric-facial nerve transposition for reanimation of the smile in incomplete facial paralysis

Incomplete facial paralysis occurs in about a third of patients with Bell's palsy. Although their faces are symmetrical at rest, when they smile they have varying degrees of disfigurement. Currently, cross-face nerve grafting is one of the most useful techniques for reanimation. Transfer of the masseteric nerve, although widely used for complete paralysis, has not to our knowledge been reported for incomplete palsy. Between December 2008 and November 2013, we reanimated the faces of 9 patients (2 men and 7 women) with incomplete unilateral facial paralysis with transposition of the masseteric nerve. Sex, age at operation, cause of paralysis, duration of denervation, recipient nerves used, and duration of follow-up were recorded. Commissural excursion, velocity, and patients’ satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. The mean (SD) age at operation was 39 (±6) years and the duration of denervation was 29 (±19) months. There were no complications that required further intervention. Duration of follow-up ranged from 6-26 months. FACIAL CLIMA showed improvement in both commissural excursion and velocity of more than two thirds in 6 patients, more than one half in 2 patients and less than one half in one. Qualitative evaluation showed a slight or pronounced improvement in 7/9 patients. The masseteric nerve is a reliable alternative for reanimation of the smile in patients with incomplete facial paralysis. Its main advantages include its consistent anatomy, a one-stage operation, and low morbidity at the donor site.

Acute flaccid paralysis surveillance: A 6 years study, Isfahan, Iran.

Background:Poliomyelitis is still an endemic disease in many areas of the world including Africa and South Asia. Iran is polio free since 2001. However, due to endemicity of polio in neighboring countries of Iran, the risk of polio importation and re-emergence of wild polio virus is high. Case definition through surveillance system is a well-defined method for maintenance of polio eradication in polio free countries.Methods:In a cross-sectional survey from 2007 to 2013, we reviewed all the records of under 15 years old patients reported to Acute Flaccid Paralysis Committee (AFPC) in Isfahan province, Iran. All cases were visited by members of the AFPC. Three stool samples were collected from each reported case within 2 weeks of onset of paralysis and sent to National Polio Laboratory in Tehran, Iran, for poliovirus isolation. Data were analyzed by SSPS software (version 22). Student's t-test and Chi-square was used to compare variables. Statistical significance level was set at P < 0.05.Results:In this 6-year period 85 cases were analyzed, 54 patients were male (63.5%) and 31 were female (36.5%). The mean age of patients was 5.7 ± 3.9 years. The most common cause of paralysis among these patients was Guillian–Barré syndrome (83.5%). We did not found any poliomyelitis caused by wild polio virus. Only one case of vaccine associated poliomyelitis was reported.Conclusion:Since 1992, Iran has a routine and high percent coverage of polio vaccination program for infants (>94%), with six doses of oral polio vaccine (OPV). Accurate surveillance for poliomyelitis is essential for continuing eradication.

Eradicating polio: how the world's pediatricians can help stop this crippling illness forever.

The American Academy of Pediatrics strongly supports the Polio Eradication and Endgame Strategic Plan of the Global Polio Eradication Initiative. This plan was endorsed in November 2012 by the Strategic Advisory Group of Experts on Immunization of the World Health Organization and published by the World Health Organization in April 2013. As a key component of the plan, it will be necessary to stop oral polio vaccine (OPV) use globally to achieve eradication, because the attenuated viruses in the vaccine rarely can cause polio. The plan includes procedures for elimination of vaccine-associated paralytic polio and circulating vaccine-derived polioviruses (cVDPVs). cVDPVs can proliferate when vaccine viruses are transmitted among susceptible people, resulting in mutations conferring both the neurovirulence and transmissibility characteristics of wild polioviruses. Although there are 3 different types of wild poliovirus strains, the polio eradication effort has already resulted in the global elimination of type 2 poliovirus for more than a decade. Type 3 poliovirus may be eliminated because the wild type 3 poliovirus was last detected in 2012. Thus, of the 3 wild types, only wild type 1 poliovirus is still known to be circulating and causing disease. OPV remains the key vaccine for eradicating wild polioviruses in polio-infected countries because it induces high levels of systemic immunity to prevent paralysis and intestinal immunity to reduce transmission. However, OPV is a rare cause of paralysis and the substantial decrease in wild-type disease has resulted in estimates that the vaccine is causing more polio-related paralysis annually in recent years than the wild virus. The new endgame strategic plan calls for stepwise removal of the type 2 poliovirus component from trivalent oral vaccines, because type 2 wild poliovirus appears to have been eradicated (since 1999) and yet is the main cause of cVDPV outbreaks and approximately 40% of vaccine-associated paralytic polio cases. The Endgame and Strategic Plan will be accomplished by shifting from trivalent OPV to bivalent OPV (containing types 1 and 3 poliovirus only). It will be necessary to introduce trivalent inactivated poliovirus vaccine (IPV) into routine immunization programs in all countries using OPV to provide population immunity to type 2 before the switch from trivalent OPV to bivalent OPV. The Global Polio Eradication Initiative hopes to achieve global eradication of polio by 2018 with this strategy, after which all OPV use will be stopped. Challenges expected for adding IPV into routine immunization schedules include higher cost of IPV compared with OPV, cold-chain capacity limits, more complex administration of vaccine because IPV requires injections as opposed to oral administration, and inferior intestinal immunity conferred by IPV. The goal of this report is to help pediatricians understand the change in strategy and outline ways that pediatricians can help global polio eradication efforts, including advocating for the resources needed to accomplish polio eradication and for incorporation of IPV into routine immunization programs in all countries.

Neurogenic Shock Immediately following Posterior Lumbar Interbody Fusion: Report of Two Cases

Study Design Case report. Objective To present two cases of neurogenic shock that occurred immediately following posterior lumbar interbody fusion (PLIF) and that appeared to have been caused by the vasovagal reflex after dural injury and incarceration of the cauda equina. Case Report We present two cases of neurogenic shock that occurred immediately following PLIF. One patient had bradycardia, and the other developed cardiac arrest just after closing the surgical incision and opening the drainage tube. Cardiopulmonary resuscitation was performed immediately, and the patients recovered successfully, but they showed severe motor loss after awakening. The results of laboratory data, chest X-ray, electrocardiogram, computed tomography, and echocardiography ruled out pulmonary embolism, hemorrhagic shock, and cardiogenic shock. Although the reasons for the postoperative shock were obscure, reoperation was performed to explore the cause of paralysis. At reoperation, a cerebrospinal fluid collection and the incarceration of multiple cauda equina rootlets through a small dural tear were observed. The incarcerated cauda equina rootlets were reduced, and the dural defect was closed. In both cases, the reoperation was uneventful. From the intraoperative findings at reoperation, it was thought that the pathology was neurogenic shock via the vasovagal reflex. Conclusion Incarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex.

I Lost Weight, but I Became Weak and Cannot Walk—A Case of Nutraceutical (T3)-Induced Thyrotoxic Periodic Paralysis

Thyrotoxic periodic paralysis (TPP) is a rare reversible cause of paralysis and cramping. TPP is usually precipitated by common causes of thyrotoxicosis such as Grave disease or multinodular goiter. TPP precipitated by exogenous triiodothyronine (T3) intake is an extremely rare occurrence with only 3 cases reported to date. We now report a 24-year-old healthy manual laborer who developed quadriparesis during a period of rest after heavy exertion and carbohydrate intake. He had severe hypokalemia (potassium level 1.9 mmole/L). Correction of his hypokalemia reversed the paralysis without rebound hyperkalemia. After a detailed history review, he reported that he had been consuming nutraceuticals containing T3 for 1 month to lose weight, and laboratory studies confirmed factitious T3 toxicosis. There was no evidence of renal or gastrointestinal potassium wasting. This episode of TPP was the first manifestation of thyrotoxicosis in this patient, and avoidance of T3 intake prevented more episodes.

Aetiology and Treatment of Vocal Fold Paralysis: Retrospective Study of 108 Patients

ObjectivesTo review the aetiology and treatment of laryngeal paralysis diagnosed at our hospital and to describe the available therapeutic options. MethodsRetrospective review of medical records of 108 patients diagnosed with unilateral and bilateral vocal fold paralysis between 2000 and 2012, identifying the cause of paralysis and its treatment. ResultsOf the 108 cases analysed, 70% had unilateral vocal fold immobility and 30% bilateral immobility. The most frequent aetiology in both cases was trauma (represented mainly by surgical injury), followed by tumours in unilateral paralysis and medical causes in bilateral paralysis. Half of the patients with unilateral paralysis (38) were treated surgically, with medialization thyroplasty. In bilateral vocal fold immobility, the treatment consisted of tracheostomy in patients with threatened airway (40%). We planned to widen the air passage in 9 patients (27%), performing cordectomy in most of them. ConclusionsThe aetiology observed in our patients is similar to that described in the literature. In cases of unilateral vocal fold paralysis, we believe thyroplasty is the procedure of choice. In bilateral paralysis, it is possible to perform cordectomy in selected patients once the airway has been secured.

Polio-like disease in the news: much ado about nothing?

Polio-like disease in the news: much ado about nothing?

Etiología y tratamiento de la parálisis laríngea: estudio retrospectivo de 108 pacientes

ObjectivesTo review the aetiology and treatment of laryngeal paralysis diagnosed at our hospital and to describe the available therapeutic options. MethodsRetrospective review of medical records of 108 patients diagnosed with unilateral and bilateral vocal fold paralysis between 2000 and 2012, identifying the cause of paralysis and its treatment. ResultsOf the 108 cases analysed, 70% had unilateral vocal fold immobility and 30% bilateral immobility. The most frequent aetiology in both cases was trauma (represented mainly by surgical injury), followed by tumours in unilateral paralysis and medical causes in bilateral paralysis. Half of the patients with unilateral paralysis (38) were treated surgically, with medialization thyroplasty. In bilateral vocal fold immobility, the treatment consisted of tracheostomy in patients with threatened airway (40%). We planned to widen the air passage in 9 patients (27%), performing cordectomy in most of them. ConclusionsThe aetiology observed in our patients is similar to that described in the literature. In cases of unilateral vocal fold paralysis, we believe thyroplasty is the procedure of choice. In bilateral paralysis, it is possible to perform cordectomy in selected patients once the airway has been secured.