Clinical scenario

This protocol addresses post-surgical unilateral vocal fold paralysis (UVFP) in which spontaneous recovery of vocal fold mobility is still expected, but the patient presents with uncompensated voice and/or aspiration that requires active management.

In this setting — uncompensated voice, aspiration, or dysphagia — a conservative wait-and-see approach is not sufficient, and more definitive intervention is indicated.

Prior treatment — goal not achieved

This protocol applies after a first-line approach using injection laryngoplasty with temporary material (the preferred initial option) or voice therapy has not achieved the primary goal of reducing penetration and aspiration.

When that threshold is not met, escalation to the next treatment step is warranted.

Treatment direction

At this stage, management moves toward permanent surgical medialization — a category of procedure aimed at achieving durable glottic closure — rather than the temporary or conservative measures used in the first line.

The specific procedure options and selection criteria are detailed in the full structured protocol.

References

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.
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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Unilateral Vocal Fold Paralysis with Uncompensated Voice or Aspiration — When Injection Laryngoplasty or Voice Therapy Has Not Reduced Aspiration

References