Glottic Closure and Relation to Swallowing

Abstract Vocal cord abduction paralysis presents a significant clinical challenge, not only because of impaired voice but more critically due to the increased risk of aspiration. The vocal cords serve as a final line of defense against the entry of food and liquids into the lower airway during swallowing. When adduction is compromised, the glottic gap prevents effective closure, predisposing patients to aspiration and its sequelae, including recurrent pneumonia, reduced pulmonary reserve, and diminished quality of life. Early and targeted intervention is therefore essential to re-establish glottic competence. Two principal surgical strategies have been shown to be effective in restoring airway protection: injection laryngoplasty and type I thyroplasty. Injection laryngoplasty, through the use of resorbable or permanent fillers, offers a minimally invasive means of medializing the paralyzed cord is particularly valuable in acute or early cases, providing immediate improvement in swallowing safety while allowing for potential spontaneous recovery of nerve function. Type I thyroplasty, on the other hand, remains the gold standard for long-term correction of unilateral vocal cord paralysis. By repositioning the immobile cord into the midline. This chapter emphasizes the critical role of vocal cord medialization in the prevention of aspiration in abduction paralysis.