SLP 477: Surgical Treatments and Prosthetics

A patient has unilateral vocal fold paralysis with aspiration. Recovery is expected within 6 to 10 weeks. Which option best matches a temporary bridge that targets glottic insufficiency?

A. Medialization laryngoplasty

B. Cricopharyngeal myotomy

C. Total laryngectomy

D. Laryngotracheal separation (LTS)

E. Gelfoam injection (temporary vocal fold injection)

E. Gelfoam injection (temporary vocal fold injection)

Which combination best captures two distinct failure modes of vocal fold injection?

A. Overinjection causes nasal regurgitation and underinjection causes reflux

B. Overinjection improves posterior closure and underinjection improves anterior closure

C. Overinjection improves upper esophageal sphincter opening and underinjection improves palatal closure

D. Overinjection can obstruct the airway and underinjection can leave closure inadequate

E. Overinjection prevents aspiration by definition and underinjection prevents residue by definition

D. Overinjection can obstruct the airway and underinjection can leave closure inadequate

A patient with terminal disease has severe voice and swallowing problems. Which injectable material is described as still used in select terminal situations despite reduced overall use?

A. Hyaluronic acid gel

B. Gelfoam

C. Hydroxyapatite

D. Collagen

E. Teflon

E. Teflon

An older injectable associated with granuloma formation is __________.

Teflon

Which option most directly addresses oral containment problems after large tongue resection when the goal is bolus control rather than airway separation?

A. Total glossectomy prosthesis

B. Laryngotracheal separation (LTS)

C. Cricopharyngeal myotomy

D. Medialization laryngoplasty

E. Arytenoid adduction

A. Total glossectomy prosthesis

A patient has a palatal defect and receives an obturator. Which outcome is the most direct measure of functional success?

A. Increased upper esophageal sphincter opening time

B. Reduced nasal regurgitation during swallowing

C. Increased posterior glottic closure strength

D. Reduced reflux acidity episodes

E. Increased laryngeal sensation

B. Reduced nasal regurgitation during swallowing

Which statement is most defensible when deciding on surgery for dysphagia?

A. Surgery is selected first to avoid behavioral management

B. Surgery is chosen whenever meals are slow

C. Surgery is considered when objective testing links a specific structural deficit to symptoms

D. Surgery decisions rarely require imaging or objective measures

E. Surgery always improves all phases of swallowing

C. Surgery is considered when objective testing links a specific structural deficit to symptoms

The permanent neck opening created for breathing after airway diversion is a _________.

stoma

Which pairing best matches procedure to its primary target structure?

A. Cricopharyngeal myotomy and vocal folds

B. Medialization laryngoplasty and upper esophageal sphincter

C. Arytenoid adduction and arytenoid position

D. Obturator and trachea

E. Laryngotracheal separation and maxilla

c. Arytenoid adduction and arytenoid position

A patient’s swallow study shows normal upper esophageal sphincter opening but severe pharyngeal weakness. Which option is least defensible as the primary surgical fix based on mechanism?

A. Cricopharyngeal myotomy

B. Dentition repair

C. Obturator

D. Arytenoid adduction

E. Medialization laryngoplasty

A. Cricopharyngeal myotomy

A patient has tissue loss after maxillary surgery with nasal regurgitation of liquids. Which intervention most directly targets the boundary problem causing the leak?

A. Obturator

B. Cricopharyngeal myotomy

C. Medialization laryngoplasty

D. Arytenoid adduction

E. Gelfoam injection

A. Obturator

Injection placed into the wrong part of the vocal fold can create __________ closure that misses the critical gap.

hourglass

A patient has suspected upper esophageal sphincter hypertonicity. Which pair best represents a short-term chemical approach and a more lasting structural approach?

A. Arytenoid adduction and Medialization laryngoplasty

B. Obturator and Palatal device

C. Dentition repair and Total glossectomy prosthesis

D. Gelfoam injection and Hydroxyapatite implant

E. Botox injection and Cricopharyngeal myotomy

E. Botox injection and Cricopharyngeal myotomy

A patient has glottic insufficiency with persistent posterior gap due to level mismatch. Which adjunctive procedure is most consistent with rotating the arytenoid to improve closure?

A. Cricopharyngeal myotomy

B. Obturator

C. Botox injection to upper esophageal sphincter

D. Arytenoid adduction

E. Total laryngectomy

D. Arytenoid adduction

A clinician is deciding between autologous fat injection and a temporary material. Which statement best reflects the key limitation of autologous fat injection?

A. It is always reabsorbed within days

B. It cannot change glottic closure

C. It is used primarily to open the upper esophageal sphincter

D. It has unpredictable results due to variable reabsorption

E. It is associated with predictable granuloma formation

D. It has unpredictable results due to variable reabsorption

An injectable with unpredictable outcomes due to variable reabsorption is

__________.

autologous fat

A patient’s primary complaint is nasal leakage of liquids. Which set of options is most likely to be distractors because they do not target oral-nasal separation?

A. Obturator and Palatal device

B. Cricopharyngeal myotomy and Botox injection

C. Dentition repair and Obturator

D. Palatal device and Dentition repair

E. Obturator and Total glossectomy prosthesis

B. Cricopharyngeal myotomy and Botox injection

Two options both aim to improve glottic closure. Which pairing best matches mechanism to procedure?

A. Posterior closure rotation and Arytenoid adduction

B. Upper esophageal sphincter relaxation and Arytenoid adduction

C. Oral-nasal separation and Medialization laryngoplasty

D. Esophageal opening and Obturator

E. Tongue propulsion and Cricopharyngeal myotomy

A. Posterior closure rotation and Arytenoid adduction

A patient has severe aspiration and undergoes surgical closure of the larynx. Which consequence is most expected?

A. Natural laryngeal speech is preserved and aspiration ends

B. Upper esophageal sphincter opening becomes normal by default

C. Oral containment automatically improves

D. The patient cannot swallow saliva at all

E. Breathing shifts to a neck opening and natural voice is usually lost

E. Breathing shifts to a neck opening and natural voice is usually lost

True or False. Laryngotracheal separation (LTS) preserves normal laryngeal speech because the larynx remains anatomically intact.

False

Which injectable material is most associated with granuloma formation and has decreased use over time?

A. Gelfoam

B. Autologous fat

C. Teflon

D. Hyaluronic acid gel

E. Collagen

C. Teflon

A patient has poor dentition and poorly fitting dentures. Which swallow-relevant mechanism best explains increased risk when chewing is inefficient?

A. Bolus remains in the esophagus longer

B. Upper esophageal sphincter becomes hyperactive

C. Bolus is inadequately broken down and arrives in large pieces

D. Vocal fold adduction becomes delayed

E. Palatal closure weakens directly

C. Bolus is inadequately broken down and arrives in large pieces

A clinician wants a fixed implant option described as human engineered rather than biologic. Which option best matches?

A. Hydroxyapatite

B. Silastic

C. Autologous fat

D. Botox

E. Gelfoam

B. Silastic

A key risk of excessive vocal fold injection is airway __________.

obstruction

A patient has a cricopharyngeal bar with bolus hold-up at the upper esophageal sphincter and significant residue that later spills toward the airway. Which short-term option is most consistent with the target?

A. Medialization laryngoplasty

B. Arytenoid adduction

C. Botox injection to upper esophageal sphincter

D. Obturator

E. Total laryngectomy

C. Botox injection to upper esophageal sphincter

A patient has severe aspiration with repeated pneumonias despite conservative management. The team wants complete airway separation from the pharynx to protect the lungs. Which option best matches that goal?

A. Arytenoid adduction

B. Medialization laryngoplasty

C. Cricopharyngeal myotomy

D. Laryngotracheal separation (LTS)

E. Obturator

D. Laryngotracheal separation (LTS)

True or False. Arytenoid adduction is used to improve posterior glottic closure when the vocal fold position creates a level or rotation mismatch.

true

A temporary injectable commonly cited as reabsorbed within weeks is __________.

gelfoam

True or False. Overinjection is desirable because it guarantees improved airway protection without meaningful downside.

a. True

b. False

false

Which option best distinguishes surgical closure of the larynx from medialization laryngoplasty?

A. Both preserve normal laryngeal speech

B. Both are temporary options intended for expected recovery

C. Medialization is used only for upper esophageal sphincter opening failure

D. Closure is a first-line option before any behavioral approach

E. Closure is aimed at preventing airway entry by eliminating the laryngeal airway

E. Closure is aimed at preventing airway entry by eliminating the laryngeal airway

A fixed implant material commonly used in medialization laryngoplasty is _________.

silastic

Which choice best distinguishes injection augmentation from medialization laryngoplasty in durability terms?

A. Injection is always permanent; medialization is always temporary

B. Injection can be temporary or variable; medialization is designed as a fixed long-term change

C. Both are identical in durability

D. Medialization is diagnostic; injection is therapeutic only

E. Injection targets the upper esophageal sphincter; medialization targets reflux

B. Injection can be temporary or variable; medialization is designed as a fixed long-term change

True or False. Gelfoam injection is preferred when a permanent, lifetime change is needed.

a. True

b. False

false

A short-term pharmacologic option to relax the upper esophageal sphincter is

__________.

botox

A ribbon-like implant option used for medialization laryngoplasty is __________.

goretex

Which statement best captures why cricopharyngeal myotomy can fail to resolve dysphagia even when performed correctly?

A. It cannot influence residue at all

B. It always causes nasal regurgitation

C. It always worsens vocal fold closure

D. It is identical in effect to dentition repair

E. It may not help when major impairment exists elsewhere in the swallow

E. It may not help when major impairment exists elsewhere in the swallow

True or False. An obturator can reduce nasal regurgitation by restoring separation between the oral and nasal cavities.

a. True

b. False

true

A patient has persistent aspiration due to long-standing glottic insufficiency and recovery is not expected. Which option is most consistent with a durable, fixed change without removing the larynx?

A. Medialization laryngoplasty

B. Gelfoam injection

C. Botox injection to upper esophageal sphincter

D. Obturator

E. Dentition repair

A. Medialization laryngoplasty

True or False. Cricopharyngeal myotomy is intended to address restricted upper esophageal sphincter opening rather than to strengthen tongue propulsion.

a. True

b. False

true

A calcium-based implant or injectable option is __________.

hydroxyapatite

Cricopharyngeal myotomy is the best choice when upper esophageal sphincter opening is normal and the primary issue is diffuse pharyngeal weakness.

a. True

b. False

false

Which outcome is most characteristic of laryngotracheal separation (LTS)?

A. Improved posterior glottic closure without stoma

B. Temporary relaxation of the upper esophageal sphincter

C. Restoration of oral-nasal separation

D. Airway separated from pharynx with a permanent neck stoma

E. Reversal of vocal fold paralysis

D. Airway separated from pharynx with a permanent neck stoma

A prosthesis designed to close an oral-nasal opening is an __________.

obturator

True or False. Medialization laryngoplasty changes glottic closure by placing a fixed implant through an open procedure.

a. True

b. False

true

The muscle cut in a cricopharyngeal myotomy is the __________.

cricopharyngeus muscle

Which implant option is most consistent with a ribbon-like material that can be layered or adjusted during medialization laryngoplasty?

A. Silastic

B. GoreTex

C. Hydroxyapatite

D. Gelfoam

E. Teflon

B. GoreTex