This protocol applies to post-surgical unilateral vocal fold paralysis (UVFP) in patients who initially presented with a compensated voice, no aspiration, and an expectation of spontaneous recovery — but whose vocal fold mobility did not return within the anticipated timeframe.
At first assessment, the patient had:
For this profile, less invasive first-line management is appropriate while awaiting potential recovery of vocal fold function.
Initial management — which may have included observation (wait-and-see), voice therapy, or injection laryngoplasty with a temporary material — did not achieve its primary goal: spontaneous recovery of vocal fold mobility within 6–12 months.
Failure to reach that endpoint triggers escalation to the current protocol.
When recovery does not occur, the clinical decision shifts toward permanent surgical medialization of the affected vocal fold. Which specific procedure is selected — and under what conditions — is outlined in the full structured regimen.
DOI: 10.21053/ceo.2020.00409
For patients with a compensated voice and no aspiration, less invasive treatment, such as a wait-and-see approach, IL with temporary material, and voice therapy are applicable, depending on the patient's need or profession, but for patients with a high vocal demand, uncompensated voice, or aspiration/dysphagia, SMPs are preferred.
Temporary or short-duration materials are used when spontaneous recovery of vocal fold mobility is expected (strong recommendation, moderate-quality evidence).
The classic clinical decision has been to wait for at least 6–12 months before conducting permanent medialization treatment in UVFP patients.
*Surgical medialization procedures indicate injection laryngoplasty, medialization thyroplasty and/or arytenoid adduction.
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