Marfan syndrome (1of 5)
70-year-old patient whose left vocal cord (right of photo) was implanted 15 years ago with a silastic wedge to rehabilitate paralysis. Voice was reported as "normal" for many years, but in recent months has deteriorated.

Marfan syndrome (2 of 5)
As the right vocal cord (left of photo) moves toward the midline, the arytenoid cartilage (white dotted line) appears to emerge from the right vocal cord without bringing the membranous segment (green dotted line) with it.

Marfan syndrome (3 of 5)
At close range, one can see more clearly that the connective tissue attachment between the arytenoid cartilage and soft tissue of the vocal cord itself has been completely lost. As in photo 2 the white dotted line marks the arytenoid cartilage and the green dotted line marks the vocal cord's membranous segment.

Marfan syndrome (4 of 5)
A different view, showing again the vocal process of the arytenoid cartilage detaching from the vocal ligament/muscle of the membranous portion of the vocal cord.

Marfan syndrome (5 of 5)
Panoramic view of the hypopharynx, showing aneurysmal dilation of the internal carotid artery (bulge on right side of photo). Epiglottis is at the center and left.