32 yrs old
Female
Radiologically diagnosed with a right vagal nerve schwannoma in 2020 (aged 28) in Liverpool. Increasing in size over 2 years. Liverpool offered surgery whilst recognising risks, reluctant to offer RT given young age. GP referred to Mr O for second opinion in Nov 2022. Listed for surgery by Mr O in April 2023. Had a planned transpetrosal excision of the lesion up to jugular foramen Jan 2024 - intra op found that tumour more in keeping with infected paraganglioma, biopsied and abandoned given unacceptable risks to nerves. Histology confirms SDHC-related paraganglioma-phaeochromocytoma and offered stereotactic RT. Pre-operatively reports occasional swallowing difficulties and chest infections, worsening voice quality over time. No documented cranial abnormalities pre-operatively. Post-operatively found to have right VC immobility and mild-moderate pharyngeal dysphagia on FEES. Referred to Laryngology and seen April 2024. VHI 10= 31, GRBAS 31331. Underwent TNL + transoral and transcutaneous Restalyne medialisation injection or right vocal fold. Commenced stereotactic radiosurgery (25Gy/5#) to paraganglioma on 18-24th July 2024 . Followed up by Laryngology in August 2024 for TNL + LEMG, VHI at this appointment 32, GRBAS 21210.

LEMG result:
(A) CT muscle right side: normal signal
(B) CT muscle left side: normal signal
(C) TA-LCA muscle complex, right side: spontaneous fibrillation activity, no volitional activity, no sinkinesis
(D) TA-LCA muscle complex, left side: normal signal

Offered MLB + RVC injection medialisation (Restylane) + right-sided non-selective laryngeal reinnervation under general anaesthesia.

PMHx: Anxiety + depression, confirmed SDHC-related paraganglioma-phaeochromocytoma syndrome = Annual plasma metadrenaline levels, annual MRI head and neck and body imaging 3-5 yearly

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45 yrs old
Female
Referred to ENT Dec 2022 with 6 month history of dysphonia. Found to have right vocal cord palsy (VHI 24, GRBAS 31321), CT skull base to diaphragm normal. Followed up March 2023, some abduction movement noted, VHI 25, GRBAS 21221, opted for conservative management with voice therapy initially. Followed up Nov 2023, VHI 17, offered trial VC medialisation injection under LA + LEMG. Underwent Transnasal laryngoscopy (TNL) under local anaesthesia + laryngeal electromyography (LEMG) Feb 2024 (VHI 17).

LEMG:
A) Left TA - normal findings
B) Right TA - difficult achievement of clear signal possibly due to muscle atrophy, no clear neurogenic changes demonstrated (full report to be uploaded in the next few days)
No immediate complications
Listed for right highly selective laryngeal neurotization (right ansa cervicalis' branch into right thyro-arytenoid muscle) + MLB + right vocal cord injection medialsiation (Restylane) under general anaesthesia.

PMHx: Fit and well