PARESE KORDAVOKALIS

Pembimbing:
Dr. Mohammad Dwijo Murdiyo, Sp. THT-KL (K), FICS

Meyland Citra
Sharon Thesalonica
Maria Evelyn
DEFINISI
Terganggunya kemampuan korda vokalis untuk
01 bergerak dan berfungsi

Dimana salah satu atau kedua pita suara tidak

02 dapat membuka ataupun menutup dengan
semestinya

Disebabkan  gangguan neurogenik pada

03 laring sehingga mempengaruhi fungsi sensoris
dan motoris laring
PATOFISIOLOGI

Daerah laring secara anatomis terdapat nervus

01 vagus dan cabangnya, yaitu nervus laringeus
recurrent yang mempersarafi pita suara

02 Penekanan maupun kerusakan terhadap nervus

03 Paralisis pita suara

Salah satu atau kedua pita suara tidak dapat

04 beradduksi

Vibrasi yang dihasilkan oleh pita suara tidak

05 maksimal
ETIOLOGI

Kongenital Didapat

Trauma Invasi Maligna Neurologik

Kelainan batang otak
N. vagus / n. laringeus Tumor pada Stroke, tumor otak,
Trauma kepala saat melahirkan rekuren basal tengkorak, maupun multiple
Bedah pada kepala, leher, kanker tiroid, sclerosis
atau dada kanker paru-
Tiroidektomi, endarterektomi paru, kanker
karotis, dan bedah tulang esofagus, dan
belakang anterior metastasis pada
mediastinum
KLASIFIKASI

Paralisis laring dapat diklasifikasikan berdasarkan temuan patologi yang

mengakibatkan terjadinya paralisis sebagai berikut:

Paralisis Laringeus Superior

Paralisis Laringeus Rekurens Unilateral

Paralisis Laringeus Rekurens Bilateral

Paralisis Lengkap
 Anamnesis
Perubahan suara
Kesulitan bernafas
Kesulitan menelan
Mudah tersedak/batuk-
batuk
Mencari kemungkinan
penyebab

Pem. Fisik
Laryngoscopy melihat pergerakan

DIAGNOSIS
dari korda vokalis untuk
menentukan sisi mana yang.
lumpuh

Pem.Penunjang
Xray, CT scans, MRI (tergantung
dugaan penyebab)
Laryngeal electromyography
(LEMG)  mengukur arus listrik
pada otot laring sehingga dapat
diketahui bila ada masalah
hantaran saraf
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GEJALA
• Kelumpuhan pita suara bisa mempengaruhi proses berbicara, bernafas dan menelan.
Kelumpuhan menyebabkan makanan dan cairan terhidup ke dalam trakea dan paru-paru.
• Jika hanya 1 pita suara yang lumpuh (kelumpuhan 1 sisi), maka suara menjadi serak.
Biasanya saluran udara tidak tersumbat karena pita suara yang normal bisa membuka
sebagaimana mestinya.
• Jika kedua pita suara mengalami kelumpuhan (kelumpuhan 2 sisi), maka kekuatan suara
akan berkurang. Penderita juga mengalami gangguan pernafasan karena terjadi
penyumbatan saluran udara ke trakea.
Infographic Style

Kelumpuhan Kelumpuhan
1 sisi 2 sisi
• Suara serak  Kekuatan suara berkurang

• Saluran udara tidak  Gangguan pernafasan karena

tersumbat terjadi penyumbatan saluran
karena pita suara udara ke trakea
yang normal bisa
membuka
 Gejala
Recurrent laryngeal nerve paralysis

Asimtomatik
Unilateral Bilateral Dyspnoea

Disfonia
Stridor
Aspirasi minimal
dan tidak ada
gangguan Suara serak
respirasi

Dapat membaik 
kompensasi plika
vokalis yang sehat
 Gejala
Superior laryngeal nerve paralysis

Unilateral Bilateral
paralisis otot Paralisis kedua
krikotiroid otot krikotiroid

aspirasi dari
Batuk dan
makanan dan
tersedak
minuman

kehilangan Suara menjadi

volume suara lemah
Gejala
COMBINED PARALYSIS

Kedua saraf
Unilateral Bilateral
mengalami
Paralisis pada paralisis
semua otot pada kedua
laring satu sisi sisi
kecuali otot
interaritenoid Jarang terjadi
KRITERIA DIAGNOSIS
Kriteria Paralisis Laringeus Paralisis Laringeus Paralisis Laringeus Paralisis Lengkap
Superior Rekurens Unilateral Rekurens Bilateral

Patologi Paralisis otot Paralisis seluruh otot Paralisis seluruh otot Lesi saraf vagus di atas
krikotiroideus intrinsik pada sisi intrinsik saraf laringeus superior
(hilangnya sensasi tersebut (unilateral atau bilateral)
separuh laring)
Efek Hilangnya nada tinggi, Suara serak, jalan Suara baik, jalan nafas Lesi serupa dengan
aspirasi nafas baik kecuali pada buruk terutama saat paralisi saraf rekurens;
anak kecil; suara nafas melakukan kegiatan lebih cenderung
& batuk buruk yang mengerahkan mengalami aspirasi
tenaga
Pemeriksaan Komisura anterior Korda vokalis dalam Korda vokalis tak Korda vokalis imobil
Fisik tampak miring ke sisi posisi paramedian, bergerak ke lateral, namun berada dalam
lesi, kartilago aritenoid tidak ada gerakan ke sebagian pasien dapat posisi intermedia akibat
pada sisi tersebut lateral beradaptasi dan tahan hilangnya fungsi aduksi
miring ke dalam dengan toleransi latihan otot krikotiroideus
yang direndahkan
TERAPI
Paralisis • Observasi, membaik setelah 6-12 bulan
karena masih ada kompensasi dari sisi
N. yang sehat
Laringeus • Gel foam, untuk membuat letak sisi
paralisis menjadi lebih medial
Rekuren • Laryngoplasty Tipe I, apabila terdapat
Unilateral inkompetensi posterior glottis

• Trakeostomi
Paralisis N.
• Operatif (transverse
Laringeus
cordatomy/ Kashman
Rekuren operation, partial
Bilateral arytenoidectomy)
TERAPI
Paralisis
N. • Trakeostomi + Cuffed tube &
Laringe oesophageal feeding tube
• Epiglottopexy
us
Superior
Parali • Trakeostomi
Gastrotomy
sis
•
• Epiglottopexy

Lengk •
•
Vocal cord plication
Total laryngectomy
ap • Diversi
 KOMPLIKASI
 Komplikasi pembedahan : suara
yang kurang baik,

 Kesulitan bernafas, dan migrasi dari

implant

 Penyebab kualitas suara yang buruk

setelah operasi adalah kesalahan
penempatan implan,
penempatannya terlalu kearah
anterior/superior, implant terlalu
kecil/besar
PROGNOSIS

 Baik
 Pada sebagian pasien prosedur operatif dapat
berhasil dengan baik sehingga mereka dapat
kembali bernafas dan bersuara normal,
tetapi pada sebagian besar pasien suara menjadi
serak atau parau meskipun jalan nafas kembali
memadai.
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