Vocal cord palsy as a sequela of paediatric cardiac surgery – a review

Abstract Background: Vocal cord palsy is one of the recognised complications of complex cardiac surgery in the paediatric population. While there is an abundance of literature highlighting the presence of this complication, there is a scarcity of research focusing on the pathophysiology, presentation, diagnosis, and treatment options available for children affected by vocal cord palsy. Materials and methods: Electronic searches were conducted using the search terms: “Vocal Cord Palsy,” “VCP,” “Vocal Cord Injury,” “Paediatric Heart Surgery,” “Congenital Heart Surgery,” “Pediatric Heart Surgery,” “Vocal Fold Movement Impairment,” “VFMI,” “Vocal Fold Palsy,” “PDA Ligation.” The inclusion criteria were any articles discussing the outcomes of vocal cord palsy following paediatric cardiac surgery. Results: The two main populations affected by vocal cord palsy are children undergoing aortic arch surgery or those undergoing PDA ligation. There is paucity of prospective follow-up studies; it is therefore difficult to reliably assess the current approaches and the long-term implications of management options. Conclusion: Vocal cord palsy can be a devastating complication following cardiac surgery, which if left untreated, could potentially result in debilitation of quality of life and in severe circumstances could even lead to death. Currently, there is not enough high-quality evidence in the literature to aid recognition, diagnosis, and management leaving clinicians to extrapolate evidence from adult studies to make clinical judgements. Future research with a focus on the paediatric perspective is necessary in providing evidence for good standards of care.

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Is a routine chest X-ray indicated before discharge following paediatric cardiac surgery?

Cardiology in the Young ◽

10.1017/s1047951109990187 ◽

2009 ◽

Vol 19 (4) ◽

pp. 370-371 ◽

Cited By ~ 3

Author(s):

Kerstin Bosse ◽

Thomas Krasemann

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Clinical Impact ◽

Chest Radiographs ◽

X Ray ◽

Paediatric Cardiac Surgery ◽

Routine Basis ◽

Chest X Ray ◽

Routine Chest

AbstractIn many paediatric cardiosurgical units, a chest X-ray is routinely performed before discharge. We sought to evaluate the clinical impact of such routine radiographs in the management of children after cardiac surgery.Of 100 consecutive children, a chest X-ray was performed in 71 prior to discharge. Of these, 38 were clinically indicated, while 33 were performed as a routine. Therapeutic changes were instituted on the basis of the X-ray in 4 patients, in all of whom the imaging had been clinically indicated. No therapeutic changes followed those radiographs performed on a routine basis.Conclusion: Routine chest radiographs can be omitted prior to discharging patients after paediatric heart surgery.

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A study of phonosurgeries in vocal dysfunction in Salem district

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203987 ◽

2020 ◽

Vol 6 (10) ◽

pp. 1783

Author(s):

K. Mahendran ◽

M. Praveen Kumar

Keyword(s):

Vocal Cord ◽

Vocal Fold ◽

Surgical Intervention ◽

Benign Lesion ◽

Vocal Cord Palsy ◽

Voice Therapy ◽

Vocal Polyp ◽

Study Population ◽

The Voice ◽

Medialization Laryngoplasty

Background: Phonosurgery essentially is surgery defined to improve or restore the voice. The objective of the study was to analyze and categorize the various benign lesions of the vocal cord causing vocal dysfunction requiring phonosurgeries, to analyze the incidence and distribution of cases according to age, sex, and etiology among the patients who require intense medical and voice therapy with surgical intervention. Methods: This prospective study was conducted in fifty patients with vocal dysfunction from the ear, neck and throat (ENT) outpatient department of Otorhinolaryngology, Mohan Kumaramangalam Government General Hospital, Salem in the year September 2018 to October 2019 who failed conservative medical and voice therapy requiring phonological procedure were included in this study. Phonomicrosurgery was done for the patients with benign vocal fold mucosal disorders and medialization laryngoplasty using Gore-Tex was done for the patients with unilateral vocal cord palsy causing vocal dysfunction.Results: The present study on phono surgery concludes vocal polyp is the commonest benign lesion of the vocal cord that constitutes 40% in our study population. Males are affected more than females. Proper investigation of voice and larynx provides the exact pathological nature of the lesion and determines the timing of surgical intervention.Conclusion: Most of the patients who underwent medialization laryngoplasty using Gore-Tex also had a good outcome at the end of the voice therapy.

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The Concept of Surgical Assessment: Part 1 – Introduction

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363510x527664 ◽

2010 ◽

Vol 92 (9) ◽

pp. 322-323 ◽

Cited By ~ 1

Author(s):

T Okoro ◽

C Sirianni ◽

D Brigden

Keyword(s):

Cardiac Surgery ◽

Royal College ◽

Heart Surgery ◽

Surgical Skills ◽

Surgical Practice ◽

Children's Hospital ◽

High Profile ◽

Paediatric Cardiac Surgery ◽

The Uk ◽

Contemporary Practice

Assessing competency in surgery is an age-old tradition. In the infancy of surgical practice the issue of competency in surgical skills was addressed by the Royal College of Surgeons of Edinburgh, one of the oldest surgical organisations. Competency in surgical skills has taken on an added urgency in contemporary practice because of several high-profile public enquiries into underperforming surgeons, such as the Bristol children's heart surgery affair in the UK, the paediatric cardiac surgery programme at Winnipeg Children's Hospital, Canada, and the Bundaberg Hospital affair in Australia.

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Right vocal cord palsy following open heart surgery

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/bf02993148 ◽

1990 ◽

Vol 42 (3) ◽

pp. 121-122

Author(s):

S. S. Arsiwala ◽

S. A. Potwar ◽

K. N. Bhosle

Keyword(s):

Vocal Cord ◽

Heart Surgery ◽

Open Heart Surgery ◽

Vocal Cord Palsy ◽

Open Heart

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Parental understanding of our communication of morbidity associated with paediatric cardiac surgery: a qualitative study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000578 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000578 ◽

Cited By ~ 1

Author(s):

Veena Rajagopal ◽

Katherine Brown ◽

Christina Pagel ◽

Jo Wray

Keyword(s):

Cardiac Surgery ◽

Focus Groups ◽

Information Needs ◽

Heart Surgery ◽

Online Forum ◽

Good Communication ◽

Paediatric Cardiac Surgery ◽

Single Transcript ◽

Set Up ◽

The Individual

BackgroundFollowing paediatric cardiac surgery, quality of life may be significantly impacted by morbidities associated with cardiac surgery. Parental understanding of the potential for postoperative morbidity is important for informed decision making. As part of a broader research study, we aimed to elicit parental understanding and experience of the communication of morbidities following their child’s cardiac surgery, using traditional focus groups together with an online forum.MethodsThe Children’s Heart Federation set up and moderated a closed, anonymous online discussion group via their Facebook page, focusing on complications, information needs and methods of providing families with information. Additionally, we ran three focus groups with parents/carers, moderated by an experienced independent professional. Focus groups were recorded and transcribed and a single transcript was generated from the online forum. All transcripts were thematically analysed.ResultsAll data were collected in 2014. The forum ran over 3 months in 2014 and involved 72 participants. Focus groups involved 13 participants. Three broad themes were identified: (1) clinicians’ use of language, (2) feeling unprepared for complications and (3) information needs of families.ConclusionsClinicians’ language is often misunderstood, with wide variability in the way morbidities are described, and between differing teams looking after the same child. Information may not be easily absorbed or retained by families, who often felt unprepared for morbidities that arose after their child’s heart surgery. Here, we propose key principles of good communication tailored to the individual receiving it.

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Clinico-etiological Profile of Vocal Cord Paralysis

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2019.v27i3.13 ◽

2019 ◽

Vol 27 (3) ◽

pp. 229-234

Author(s):

Shivakumar Senniappan ◽

Govind Krishnan Gopalakrishnan ◽

Chinnu Sudha Kumar ◽

Anjali Mahendra Panicker ◽

Visakh Kookkal Nair ◽

...

Keyword(s):

Vocal Cord ◽

Vocal Fold ◽

Vocal Cord Paralysis ◽

Vocal Cord Palsy ◽

Vocal Fold Paralysis ◽

Cross Sectional ◽

One Year ◽

Underlying Pathology ◽

Peripheral Origin ◽

Rule Out

Introduction Vocal Cord Paralysis may be of central or peripheral origin based on the underlying pathology. Central Causes contribute about 10% while peripheral causes about 90% and the current study evaluated the clinical profile of vocal cord paralysis. Materials and Methods A cross-sectional observational study was conducted in the department of ENT for a period of one year. Patients with complaints of hoarseness or aspiration who on laryngoscopy examination with 45° telescope have been diagnosed to have vocal cord paralysis were included for the study. A total of 83 patients were included in our study. Results Vocal cord palsy was found most commonly after thyroidectomy (20.4%) followed by the idiopathic cause (19.2%). Certain cancers like lung cancer and neck cancers (hypopharyngeal, laryngeal and thyroid) carcinoma had also contributed significantly in the development of vocal cord palsy. Left sided vocal cord palsy (65%) was found to be the commonest side affected followed by bilateral vocal cord palsy. Conclusion A proper protocol is necessary for identifying the factors responsible for vocal fold paralysis which would help in managing the condition more effectively. Before making a diagnosis as idiopathic vocal cord paralysis, detailed investigations should be carried out to rule out the possibilities of cancer, causing vocal cord paralysis.

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