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5 results

  • The circumstances in which recurrent laryngeal nerve palsy occurs after surgery for benign thyroid disease: a retrospective study of 1026 patients

  • D Lenay-Pinon, A Biet-Hornstein, V Strunski, C Page
  • Journal:
    The Journal of Laryngology & Otology / Volume 135 / Issue 7 / July 2021
    Published online by Cambridge University Press:
    14 June 2021, pp. 640-643
    Print publication:
    July 2021
  • Objective

    To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery.

    Methods

    This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study.

    Results

    With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors.

    Conclusion

    Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.

  • Outcomes in two patients with vocal fold palsy who underwent revision arytenoid adduction surgery

  • K Matsushima, H Matsui, S Ohira, K Matsuura
  • Journal:
    The Journal of Laryngology & Otology / Volume 133 / Issue 11 / November 2019
    Published online by Cambridge University Press:
    07 October 2019, pp. 1017-1020
    Print publication:
    November 2019
  • Objective

    This study investigated the position of adduction thread attachment, pulling direction and fixation position in revision arytenoid adduction surgery performed in two patients with left vocal fold palsy in whom satisfactory speech improvement had not been obtained by arytenoid adduction and type 1 thyroplasty.

    Methods

    Revision arytenoid adduction surgery was performed with the vocal fold in the midline position in both cases. A type 1 thyroplasty procedure was subsequently added in one case because of worsened quality of speech following arytenoid adduction.

    Results and conclusion

    Although the arytenoid adduction procedure is conceptually well established, there is still room for debate concerning the actual surgical procedures used. The technique described in this report is effective, suggesting that it is worthy of recognition as an index procedure.

  • Unilateral vocal fold paralysis: can laryngoscopy predict recovery? A prospective study

  • J K R Menon, R M Nair, S Priyanka
  • Journal:
    The Journal of Laryngology & Otology / Volume 128 / Issue 12 / December 2014
    Published online by Cambridge University Press:
    17 November 2014, pp. 1095-1104
    Print publication:
    December 2014
  • Objective:

    To determine the prognostic value of laryngoscopy in predicting the recovery of unilateral vocal fold paralysis.

    Method:

    A prospective study was carried out of all patients with unilateral vocal fold paralysis without a progressive lesion or arytenoid dislocation.

    Results:

    Among the 66 candidates, 15 recovered. Patients with interarytenoid paralysis (p < 0.001) or posterolateral tilt of the arytenoid (p = 0.028) had less chance of recovery. Among 51 patients who did not recover, 25.49 per cent regained phonatory function by compensatory movement of the normal side; the rest required an intervention. Intervention requirement was significantly less for those patients who had isolated glottic level compensation. The paralysed vocal fold was at the same level in 32.35 per cent of patients, higher in 38.23 per cent and lower in 29.42 per cent. In those in whom vocal folds were in the abducted position (46.67 per cent), the affected vocal fold was at a lower position on phonation. Inter-observer reliability assessment revealed excellent to good agreement for all criteria.

    Conclusion:

    Interarytenoid paralysis and posterolateral tilt of the arytenoid were predictors of poor recovery.

  • A precricoid swelling in a patient treated with Teflon injection in the vocal fold after idiopathic left vocal fold palsy

  • J. A. D. Jol, R. Y. Seedat, D. W. Skinner
  • Journal:
    The Journal of Laryngology & Otology / Volume 112 / Issue 9 / September 1998
    Published online by Cambridge University Press:
    29 June 2007, pp. 878-879
    Print publication:
    September 1998

  • Vocal fold palsy is a cause of dysphonia. Due to incomplete glottic closure during phonation, patients with a unilateral vocal fold palsy present with a weak and breathy voice and recurrent aspiration. To lessen the clinical manifestations of unilateral vocal fold palsy, polytetrafluoroethylene (Teflon) paste is one agent which has been injected into the paraglottic region, thus causing the vocal fold to move more medially. One of the complications associated with Teflon paste injection is migration of the paste into the surrounding tissues. We present a patient with idiopathic left vocal fold palsy who underwent Teflon injection to the vocal fold and subsequently developed a precricoid nodule, mimicking a cartilaginous swelling.

  • Vocal fold palsy following vinca alkaloid treatment

  • B. V. Burns, J. C. Shotton
  • Journal:
    The Journal of Laryngology & Otology / Volume 112 / Issue 5 / May 1998
    Published online by Cambridge University Press:
    29 June 2007, pp. 485-487
    Print publication:
    May 1998

  • We report two patients with Hodgkin's disease on chemotherapy, one with vincristine, the other with vinblastine, who were referred to the ENT department with a vocal fold palsy. These drugs are commonly used in the treatment of haematological malignancies, and head and neck sarcomas. Examination showed a unilateral immobile fold. No causative local pathology was identified, and they were otherwise thought to be achieving remission, but the development of a fold palsy suggested a poor response to treatment. One patient's palsy resolved following completion of chemotherapy, but the other patient's persists, despite an otherwise good response to the treatment. The vinca alkaloids are neurotoxic, usually causing a peripheralneuropathy, but cranial mononeuropathies are a rare side-effect. A total of 27 previous cases of vocal fold palsy have been reported with the use of the vinca alkaloids, and such a lesion should not be assumed to be due to advancing lymphoma.