CT of the fixed vocal cord

The presence or absence of mobility of the vocal cords is one of the major clinical criteria used in staging laryngeal cancer. Decisions regarding radical laryngectomy may be made on the basis of vocal cord mobility rather than an appraisal of the actual tumor extension. Seventy-one patients in whom the status of vocal cord mobility was clinically proven was studied by computed tomographic (CT) scanning. CT showed two cancers to be more advanced than estimated by normal vocal cord motion due to involvement of the preepiglottic or subglottic space. In three patients with suspected laryngeal tumor presenting with neck pain and hoarseness, CT showed that the sequelae of "occult" trauma had limited vocal cord mobility and had given a false clinical impression of possible tumor. CT correctly predicted vocal cord fixation in 16 of 19 patients with tumor and in eight of nine patients after trauma. In both groups, most patients had multiple findings which could explain fixation. In the tumor group, cricoarytenoid involvement (12 instances) and paralaryngeal space spread (10 instances) were the most frequent. In the trauma group, injuries to the laryngeal skeleton (nine instances) and a variety of soft tissue changes (seven instances) were the most frequent findings, related to fixation.
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