Surgical Management of Vocal Cord Paralysis: The Need for Careful Patient Selection (original) (raw)
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Vocal Cord Paralysis –An Etiological Analysis
Scholarly Journal of Otolaryngology, 2020
Introduction: Vocal cord paralysis is the total interruption of nerve impulse resulting in absence of laryngeal muscle movement. The most common type of vocal cord paralysis found is due to recurrent laryngeal nerve injury. The pathology can be either along the course of the tenth cranial nerve from cerebral cortex to neuromuscular junction or could be from mechanical fixation of cricoarytenoid joint. Objective: To study the various etiological factors contributing to vocal cord paralysis. Materials and methods: Patients with vocal cord paralysis [unilateral and bilateral] who were treated at a tertiary institute for a period of 3 years were included. The immobility of cords was assessed with the use of indirect laryngoscopy via mirror or rigid angled telescopy or flexible laryngoscopy. The patients were categorized based on laterality of paralysis as well as based on various etiological factors into groups. Appropriate statistical analysis was done. Results: Among 50 patients, 84 % cases had unilateral vocal cord paralysis. Surgical cause was found to be the most common etiology of unilateral vocal cord paralysis (34%) closely followed by idiopathic (18%) and neoplasm (16%). In bilateral vocal cord paralysis, surgical and neurological causes were found to be the main causative factor. Conclusion: Vocal cord paralysis has a wide range of factors contributing to its occurrence with surgical cause being a common one. A comprehensive assessment of patient should be performed to determine the cause which facilitates a direct treatment plan.
latrogenic and Idiopathic Vocal Cord Paralysis: A Real Obligation of Endoscopic Appraisal
Global Journal of Medical Research, 2020
Background: Thelarynx is an inevitable mouthpiece of the human body which has to execute very associated assignment like protection, respiration, and phonation. To fulfill this mission, the larynx should be accommodated, integrated, and sensible. The vocal cord is the concern of larynx, which served all-purpose. If any occurrence due to iatrogenic, idiopathic, or any other causes shut down the vocal cord mobility, the patient is facing miserable complexity in their life. Methods: It is a cohort retrospective study of 67 cases in the department of otolaryngology and Head-Neck Surgery, Bangladesh, from 01 July 2016 to 31 June 2019. Results: Incidence among outpatient was 0.06%, inpatient was 0.37%, and total laryngeal disorder, and thyroid operation was 6.51%. Of them unilateral was 64(95.52%) in which both right and left were equal 32(50%) bilateral were 3(2.99%), male were 28(41.79%), and females were 39(58.21%). Amidst them 00-18 years were 2(2.99%), 19-40 years were 21(31.34), 41-...
Outcome and changing cause of unilateral vocal cord paralysis1
Otolaryngology - Head and Neck Surgery, 1998
Unilateral vocal cord paralysis (UVCP) is relatively common, and previously, thyroidectomy used to be the leading cause. We retrospectively reviewed 98 cases of UVCP. The left vocal cord was involved in 70% of the cases and the right vocal cord in 30%. The cause was neoplastic in 32%, surgical in 30%, idiopathic in 16%, traumatic in 1 I%, central in 8%, and infectious in 3% of the cases. Only 4 cases were the result of thyroid surgery. Evaluation consisted of a review of the history, a physical examination, and computerized scanning or magnetic resonance imaging, as needed. The functional recovery rate as related to the cause was as follows: surgery 3 I%, idiopathic 19%, traumatic 18%, and neoplastic 0%. Thirty-five percent of patients required medialization laryngoplasty or Teflon injection. Lung and skull base tumors and their surgical treatment are the most common causes of UVCP.
North American Journal of Medical Sciences, 2013
Background: Vocal cord paralysis continues to be an important issue in laryngology and is considered as a sign of underlying disease; the etiologies of this problem are varied and changing. Aims: The study was to carry out a retrospective analysis of patients with unilateral vocal fold paralysis diagnosed. Materials and Methods: The medical records of 53 patients diagnosed and treated for unilateral vocal fold paralysis were studied retrospectively. Data regarding age, sex, duration of symptoms, etiology, and side of paralysis were recorded. Results: Out of the 53 cases, 36 were females and 17 males with a ratio of 2.1:1. The age of the patients ranged from 17-75 years. In 18.9% the cause was idiopathic. Surgical trauma (iatrogenic) problems was the most encountered etiology (66%), others included malignancy (non laryngeal) (7.5%), central (3.8%), external neck trauma (1.9%) and radiation therapy 1.9%. Thyroid surgery was the most commonly reported neck surgery in 50.9%. Conclusions: Thyroidectomy continues to be the single most common surgical procedure responsible for unilateral vocal cord paralysis. For this reason, routine pre and postoperative laryngoscopy should be considered in all patients undergoing surgeries with a potential risk for recurrent nerve paralysis to reduce the postoperative morbidity.
Two trajectories of functional recovery in thyroid surgery related unilateral vocal cord paralysis
Surgery, 2020
Background: Iatrogenic unilateral vocal fold paralysis caused by thyroid surgery induces profound physical and psychosocial distress in patients. The natural course of functional recovery over time differs substantially across subjects, but the mechanisms underlying this difference remain unclear. In this study, we examined whether the anatomic site of the lesion affected the trajectory of recovery. Methods: In this prospective case series study in a single medical center, patients with thyroid surgery erelated unilateral vocal fold paralysis were evaluated using quantitative laryngeal electromyography, videolaryngostroboscopy, voice acoustic analysis, the Voice Outcome Survey, and the Short Form-36 quality-of-life questionnaire. Patients with and without superior laryngeal nerve injuries were compared. Results: Forty-two patients were recruited, among whom 15 and 27 were assigned to the with and without superior laryngeal nerve injury groups, respectively. Compared with the group without superior laryngeal nerve injury, the group with superior laryngeal nerve injury group demonstrated less improvement in the recruitment of vocal fold adductors, and the group also had more severe impairment of vocal fold vibration, maximum phonation time, jitter, shimmer, and harmony-to-noise ratio at the first evaluation. This difference was also found in the glottal gap and maximum phonation time 12 months after the injury. Conclusion: Among patients with thyroid surgeryerelated unilateral vocal fold paralysis, superior laryngeal nerve injury induces a distinctively different recovery trajectory compared with those without superior laryngeal nerve injury characterized by less reinnervation of vocal fold adductors and worse presentation in terms of the glottal gap and maximum phonation time. This study emphasizes the importance of superior laryngeal nerve function and its preservation in thyroid surgery.
IntechOpen eBooks, 2023
Vocal cord paralysis can be due to neurogenic cause, trauma due to surgery, or mechanical fixation of the cords. Diagnosis of the underlying cause leading to paralysis of the vocal cords is important. Most commonly, there is paralysis of recurrent laryngeal nerve. Treatment depends on the cause and whether the cord paralysis is unilateral or bilateral. Unilateral paralysis patients usually present with change in voice, regurgitation, and difficulty in swallowing. One-third of them they show spontaneous recovery, due to compensatory movement of opposite healthy vocal cord. Speech therapy is useful during initial conservative management period. In rest of the cases, vocal cord medialization procedures are performed. As for bilateral vocal cord paralysis which is troublesome entity, patients present with severe symptoms of respiratory distress, stridor, and aspiration. Voice is usually normal in bilateral paralysis cases but change in pitch, poor intensity, and voice fatigue are the complaints. The primary objective is to relieve patients' dyspnea. There are different treatment options available for bilateral vocal cord paralysis such as tracheostomy, arytenoidectomy, cordectomy, botulinum toxin injection, re-innervation procedures. All these procedures have been applied in with varying success. Unilateral cord paralysis is more common and has better prognostic outcomes as compared to bilateral vocal cord paralysis.
Romanian Journal of Legal Medicine, 2012
Purpose: We conducted a retrospective descriptive study comprising the patients diagnosed with vocal cords paralysis in the ENT Clinic from Coltea Clinical Hospital Bucharest in order to inventory the iatrogenic cases. Scientific background: The leading causes are trauma for vocal fold paralysis and paresis both surgical and nonsurgical, neoplasm and central nervous system diseases. Even with the multitude of current modern diagnostic investigations a large number of cases remain idiopathic. Adults suffer unilateral paresis more often than bilateral disease and left-sided lesions account for around two thirds of unilateral cases. The leading operation responsible for iatrogenic injury to both vocal folds is the total thyroidectomy. Intubation injuries commonly cause bilateral disease. Patients and methods: The descriptive analysis of our study group focused on gender distribution, age groups distribution, types of lesions according to ICD10 criteria and identifying current etiologies such as: surgery, neoplasm, idiopathic, CNS lesions, intubation, etc. Results and discussions: According to our data the study group presents numerous specific characteristics: male predominance, almost equal distribution between rural and urban living environment, maximum number of cases in between the ages of 55 and 74 years, etc. We have identified 23,40% iatrogenic lesions. Unfortunately almost all the bilateral lesions were associated with thyroid surgery. Conclusions: There are a great number of bilateral and unilateral iatrogenic lesions associated with surgical procedures because Romania is endemic for thyroid pathology Key Words: vocal fold paralysis and paresis, iatrogenic injury, total thyroidectomy, laryngeal nerve lesions, phonosurgery.
VOCAL FOLDS PARALYSIS AND CAUSES DETERMINING FACTORS: A LITERATURE REVIEW (Atena Editora)
VOCAL FOLDS PARALYSIS AND CAUSES DETERMINING FACTORS: A LITERATURE REVIEW (Atena Editora), 2022
The paralysis of pleats vocal cords (PPV) is a pathology resulting from the lesion of the superior and recurrent laryngeal nerves, which innervate the intrinsic muscles of the larynx. Common symptoms include voice change, hoarseness, and aspiration. of food. The objective of this work is to carry out a study on the most frequent of that paralysis, well as about sex and age of patients affected. This is a systematic review, with articles from 2014 to 2018 about of the PPV, selecting the 10 most relevant. The observed results were the equitable incidence between the sexes, with a mean of 54.3 years, and the highest prevalence due to iatrogenic injury in thyroidectomy surgeries. PPV is generated per lesion us nerves laryngeal higher and/or recurrent, per surgeries, tumors, intubation. patients affected present hoarseness, dysphonia and dyspnea. Electroneuromyography of the larynx muscles is a good method for elucidate such cases. Therefore, it is important to consider factors such as age and prevalence in causes for that condition, the end in catch up a diagnosis need. Still, no if can leave out less common causes, such as laryngitis, then only considering all those factors, it is possible to define a more efficient therapeutic approach.
Methods of surgical treatment of bilateral vocal fold paralysis
Endokrynologia Polska
Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.
ARYTENOIDCORDECTOMY FOR BILATERAL VOCAL CORD PARALYSIS: PRIMARY AND REVISION PROCEDURE
Background: Definitive enlargement of the glottis with preservation of adequate voicing in patients with bilateral recurrent nerve paralysis remains a surgical challenge especially in patients with previous unsuccessful surgery. Study design: Report of a novel surgical technique for glottis enlargement and presentation of midterm results. Methods: Four adult patients with bilateral recurrent nerve paralysis were subjected to submucosal arytenoidcordectomy through a thyreofissure approach with ventricular folds transposition and long-term translaryngeal stenting. Two of them had had previous surgeries at the glottic level. Preoperative data as well as postoperative functional results are reviewed. Follow- up ranged from 8 to 28 months. Results: In all patients tracheostomy closure was achieved. Midterm follow-up revealed stable airway, adequate for the patients’ routine physical activities. Postoperatively patients phonated with the ventricular folds and the resulting voice quality was good. Conclusions:We describe a novel approach formanagement of impaired airway because of bilateral recurrent nerve paralysis and/or stenosis. It comprises intralaryngeal soft tissue resection, enlargement of the cartilaginous framework of the larynx and long-term translaryngeal stenting. The surgical approach described here proved to be successful both in patientswith simple bilateral vocal fold motion impairment and in those, who have been already unsuccessfully treated with other surgery. Nevertheless the technique should be regarded as an option only in complicated revision cases, rather than a primary intervention in bilateral vocal fold paralysis. Key words: vocal fold paralysis failure, laryngeal stenosis, arytenoidectomy, cordectomy, translaryngeal stenting.