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see also: Case example EMG guided laryngeal Botox Injection; Case Example Vocal Tremor Response to Botox; Unilateral Laryngeal Paralysis or Vocal Cord Paralysis

Return to protocol: Laryngeal EMG (Electromyography)

Anatomy from cadaver laryngeal dissection - images available above by clicking on thumbnails

Video of laryngeal EMG

Placement of bipolar hooked wire electrode into the TA muscle via percutaneous trans-cricothyroid membrane puncture with a 25 gauge needle.

After appropriate positioning (neck partially, not fully extended - slightly reclined), landmarks are confirmed by palpation: hyoid, thyro-hyoid, thyroid cartilage and cricoid cartilage (local anesthesia 1% with 1:100,000 already injected superficially).

The index and second finger (left hand) palpate the cricothyroid space and gently push down on the skin to secure the location of needle placement and diminish the distance from the skin to the cricothyroid membrane.

The hooked wire electrodes (two filaments with a 180 bend at their exit from the 25 gauge needled) are placed in a subepithelial manner through the skin into either the TA or LCA (through the cricothyroid membrane) or into the CT superficial to the membrane.

See Laryngeal EMG (Electromyography) protocol for placement into specific muscles.