A Clinical Study of Bilateral Recurrent Laryngeal Nerve Paralysis.
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Abstract:
Twenty-three patients with bilateral recurrent laryngeal nerve paralysis treated at our clinic over the past 15 years were studied. The vocal cord was fixed in a paramedian position in twelve patients, in a median position in ten patients and in our intermediate position in one patient. No surgical treatment was performed in ten patients, while thirteen patients were surgically treated. Surgical procedures were undertaken as follows: tracheotomy in three patients, endoscopic lateralization of the vocal cord by Kirchner's method in two patients, widening of the anterior glottis combined with Woodman's operation in one patient, arytenoidectomy in five patients, thyroplasty type I (Isshiki's method) in one patient, glottic closure in one patient and laryngectomy in one patient. From our long term observations, we think that arytenoidectomy is the simplest and most reliable method for reducing the laryngeal obstruction in bilateral recurrent nerve paralysis.Keywords:
Tracheotomy
Laryngeal paralysis
Vocal Cord Paralysis
Recurrent nerve
Laryngeal paralysis
Neck dissection
Recurrent nerve
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We performed arytenoidectomies under microlaryngoscopy in three cases, two males and one female, suffering from severe dyspnea secondary to vocal cord paralysis. In all three cases, a tracheostomy was made prior to the surgery. In two of the cases, bilateral paralysis of the vocal cords was found, while the other case showed a narrow glottis with left vocal cord paralysis and a twisted larynx from the thyroid carcinoma. After arytenoidectomy, the dyspnea was improved in all three cases, and the tracheostoma was closed in the former two cases. Although several surgical techniques have been reported for patients with narrow glottis, most of them present some technical difficulties. A microlaryngoscopic approach for arytenoidectomy requires no incision, and the technique is relatively easy compared to other methods and useful for the treatment of dyspnea due to vocal cord paralysis.
Vocal Cord Paralysis
Arytenoid cartilage
Thyroid cartilage
Cordectomy
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We investigated whether laryngeal images can be used to determine the pathological condition and effects of treatment in daily observations.Fifty-four patients underwent intracordal fat injection with autologous fat between December 2003 and December 2012 at the Tokyo Hospital of Tokai University. The pre-operative laryngeal findings of these cases were assessed retrospectively.In terms of the association between the laryngeal images and the pre- and post-operative maximum phonation times, a significant relationship was noted with both pre- and post-operative maximum phonation times in cases in which a gap was found on the posterior portion of the glottis. In particular, the presence of a gap in the posterior region of the glottis was related to the maximum phonation time, and significantly related to improvements in voice following autologous fat injection.
Laryngeal paralysis
Vocal fold paralysis
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Paresis
Vocal Cord Paralysis
Superior laryngeal nerve
Laryngeal paralysis
Vocal folds
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Abstract Objective To assess the extent of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) damage in patients with idiopathic vocal cord paralysis (IVCP) exhibiting different paralytic sides. Methods A total of 84 IVCP cases were evaluated using stroboscopic laryngoscopy, voice analysis, and laryngeal electromyography (LEMG). The results were compared between patients with left‐sided paralysis and right‐sided paralysis based on different disease courses (less than or more than 3 months). Results Initially, the average age and disease progression of IVCP patients were found to be similar regardless of the side of paralysis ( p > .05). Additionally, there were no significant variations in voice indicators, such as MPT, DSI, and VHI, between IVCP patients with left and right vocal cord paralysis ( p > .05). Furthermore, no disparities were detected in the latencies and amplitudes of the paralyzed RLN and SLN, as well as the durations and amplitudes of the action potentials in the paralyzed TM and PCM, among IVCP patients with left and right vocal cord paralysis ( p > .05). Notably, the amplitudes of the left paralytic CM were significantly lower than those of the right paralytic CM (0.45 vs. 0.53, Z = −2.013, p = .044). In addition, no disparities were observed in APDs and amplitudes between the ipsilateral PCM and TM, either for patients with left or right vocal fold paralysis ( p > .05). Finally, all the IVCP patients were subdivided into two subgroups according to different disease course (less than or more than 3 months), and in each subgroup, the comparison of voice indicators and LEMG results in IVCP patients with left or right vocal fold paralysis were similar with the above findings ( p > .05). Conclusion Overall, the degree of RLN and SLN damage appeared to be similar in IVCP patients with left and right vocal cord paralysis, provided that the disease course was comparable. Level of Evidence 4.
Vocal Cord Paralysis
Laryngeal paralysis
Vocal fold paralysis
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Over a period of 5 years, 323 patients underwent an operation on a goiter. A postoperative paralysis of the recurrent laryngeal nerve occurred in 31 patients, most in malignancies and recurrent goiters. 26 patients were controlled at least 1 year after operation. 65% of the patients have a fully recovered voice and normal vocal cord function. Another 14% showed a normal voice for daily use by functional compensation of the paralysis. Only in 4 patients (16%) the operation resulted in a permanent modest or severe hoarseness as consequence of a thyroidectomy in cancer.
Recurrent nerve
Vocal Cord Paralysis
Laryngeal paralysis
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Recurrent nerve
Laryngeal paralysis
Vocal fold paralysis
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In the cases complicated with the vocal cord paralysis following thyroidectomy, 3 cases with a full healing, which were interesting from the standpoint of the vulnerability of the recurrent laryngeal nerve at the operation and in the laryngoscopic and electromyographic findings of the intrinsic laryngeal muscles during the period in the paralysis, were reported.For the vocal cord paralysis following thyroidectomy, the next conclusions were obtained by recording the electromyography of the intrinsic laryngeal muscles with the lapse of time after the operation.(1) Although the vocal cord appearently shows the fixation, the intrinsic laryngeal muscles at the paralytic side are to be in various conditions, which can have various influences on the laryngoscopic findings.(2) Of factors that have influences on the fixation of the vocal cord, not only the nerve paralysis, but also the unbalance of the activity of the intrinsic laryngeal muscles and the disturbance of the arytenoid joint must be considered.(3) Electromyography of the intrinsic laryngeal muscles is significant in observation of the clinical process and judging the prognosis of the recurrent laryngeal nerve paralysis.
Laryngeal paralysis
Vocal Cord Paralysis
Superior laryngeal nerve
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Temporary or permanent vocal cord paralysis caused by recurrent laryngeal nerve injury is one of the relatively common and serious complications of thyroid surgery. At the same time, there are many reasons for recurrent laryngeal nerve injury. Therefore, the recurrent laryngeal nerve should be paid attention to before, during and after thyroid surgery. A 51-year-old woman was diagnosed with left papillary thyroid carcinoma. Unfortunately, the patient had a history of hoarseness following a patent ductus arteriosus ligation. We operated on her for thyroid cancer. Preoperative electronic laryngoscopy revealed paralysis of the left vocal cord, and intraoperative nerve monitor showed no signal of the left vagus nerve and recurrent laryngeal nerve. There was no improvement in hoarseness symptoms during postoperative follow-up three months. There are many causes of vocal cord paralysis. In addition to the central injury, any nerve injury of vagus nerve from the brainstem nucleus suspicius to the laryngeal muscle pathway it innervates can cause vocal cord paralysis. Paying attention to the recurrent laryngeal nerve before, during and after surgery can effectively reduce the vocalization of recurrent laryngeal nerve injury.
Vocal Cord Paralysis
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Vocal Cord Paralysis
Recurrent nerve
Vocal Cord Dysfunction
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