Lip and tongue trills
Lip and tongue trills aid in the balance of resonance, as well as coordinate the muscles of respiration, phonation and articulation. In addition, subglottal pressure may increase during lip trills, and result in the generation greater vocal fold vibration. Surgery
After 9 months of observation, should the paralysis not resolve and the patient be dissatisfied with the outcomes of voice therapy, the next option is temporary injection medialization. In this procedure, a variety of materials can be injected into the body of the vocal fold in order to bring it closer to the midline of the glottis. Materials such as Teflon, autologous fat, collagens acellular dermis, fascia, hydroxyapatite and hyaluronates are available to be used in the procedure. The choice of substance is dependent on several factors, taking into consideration the specific condition and preference of the patient as well as the clinical practice of the surgeon. The materials serve the purpose of filling up the vocal folds and increasing their volume. This allows the paralyzed vocal fold to make contact with the alternate fold, in order to more efficiently produce phonation. While injection augmentation has been long considered best practice, neither technique nor materials used have been standardized across clinicians. With this, results prove to be both safe and effective, but variable in their duration, lasting anywhere from 2 to 12 months.For patients with significant paralysis at 12 months post-onset, medialization thyroplasty may be suggested.
Cluttons joints is a term describing the finding of symmetrical joint swelling seen in patients with congenital syphilis. It most commonly affects the knees, presenting with synovitis and joint effusions (collections of fluid within the joint capsules) lasting up to a year. It has also been reported affecting the ankles, elbows, wrists and fingers. It is usually painless, although pain in the absence of trauma can occur in a few cases. There is usually no disability associated with the joint swelling, and recovery is usually complete. It occurs between 5 and 20 years of age in both sexes.The condition was described in 1886 by Henry Hugh Clutton in The Lancet. == References ==