Rehabilitation Therapy for Vocal Fold Paralysis Caused by Lung Cancer: A Case Report

Abstract Objective Unilateral vocal fold paralysis (UVFP) can be caused by iatrogenic injury or tumor-induced damage to the recurrent laryngeal nerve. Studies of comprehensive rehabilitation therapies for patients suffering from severe UVFP are limited. The purpose of this case report is to describe an improvement in complete aphonia after comprehensive rehabilitation therapies in a patient with severe UVFP due to a lung tumor. Methods An 81-year-old woman with a history of bronchial adenoma had complete aphonia due to compression of the left recurrent laryngeal nerve by the tumor. Dynamic fibrolaryngoscope revealed paralysis of the left vocal fold. The patient was treated with interferential current therapy, vocal training, and kinesiology taping. Indicators of voice recovery were scored according to the grade, roughness, breathiness, asthenia, strain scale, and the voice handicap index. Results After 10 days of comprehensive rehabilitation treatment, the patient recovered from complete aphonia to normal communication. The hoarseness and breathiness of patient were significantly improved. In addition, the grade, roughness, breathiness, asthenia, strain, and the voice handicap index scores changed from severe to mild or absent. Conclusion This case provided a novel comprehensive treatment for a patient with UVFP, which was safe, cost-effective, and easy to implement in clinic.

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Laryngeal reinnervation in unilateral vocal fold paralysis- case report and literature review

Polski Przegląd Otorynolaryngologiczny ◽

10.5604/01.3001.0010.0932 ◽

2017 ◽

Vol 6 (2) ◽

pp. 36-41

Author(s):

Anna Rzepakowska ◽

Justyna Jachimowska ◽

Kazimierz Niemczyk

Keyword(s):

Case Report ◽

Recurrent Laryngeal Nerve ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Laryngeal Nerve ◽

Functional Abilities ◽

Unilateral Vocal Fold Paralysis ◽

Ansa Cervicalis ◽

Laryngeal Reinnervation ◽

The Voice

Laryngeal reinnervation is the method of treatment in unilateral vocal fold paralysis. During the surgery an anastomosis between the main branch of ansa cervicalis and recurrent laryngeal nerve is formed. Regeneration of the nerve’s functional abilities is a long process, lasting from 4 to 6 months, up to a year. A 35 year-old male was admitted to the Department of Otolaryngology at Warsaw Medical University in order to undergo surgical removal of reoccurrence of Schwannoma in left cerebellopontine angle by translabyrinthine approach. Post-operative period was complicated with vagal nerve paralysis. The patient reported hoarseness, dysphagia and choking. Physical examination revealed left vocal fold immobilization in abducted position, saliva in piriform fossa and left-sided soft palate paralysis yet the patient was discharged home. 4 weeks after the surgery, the patient was admitted to the hospital again due to developing aspiration pneumonia. Augmentation of the left vocal fold with calcium hydroxyapatite was performed 2 months later. After this intervention temporary vocal improvement and choking frequency reduction was observed. Finally, the patient underwent laryngeal reinnervation with formation of ansa cervicalis main branch to recurrent laryngeal nerve anastomosis. Left vocal fold regained its functional abilities and the quality of the voice improved. Laryngovideostroboscopy performed 6 months later revealed mobilization of left vocal fold sufficient for proper glottis closure. The voice measures normalized and the swallowing improved. Conclusions This case report and analyzed data confirm that laryngeal reinnervation surgery in unilateral vocal fold paralysis helps achieve satisfactory effects in voice function and life quality.

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Schwannoma of the larynx: case report, and review of the literature

The Journal of Laryngology & Otology ◽

10.1017/s0022215100128130 ◽

1994 ◽

Vol 108 (9) ◽

pp. 788-790 ◽

Cited By ~ 12

Author(s):

Musa N. Jamal

Keyword(s):

Case Report ◽

Ct Scan ◽

Recurrent Laryngeal Nerve ◽

Surgical Approach ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Left Ventricular ◽

Laryngeal Nerve ◽

Review Of The Literature ◽

Carotid Sheath

AbstractA case of schwannoma of the larynx is reported. It originated from the left ventricular fold submucosally and extended to the left side of the neck outside the larynx near the carotid sheath. It presented with stridor. CT scan showed a mass in the larynx which had fractured the left thyroid lamina and extended into the neck. An external surgical approach was used and the mass was removed in toto without laryngofissure. Left vocal fold paralysis was noticed during laryngoscopy at the time of the operation. The possibility that the tumour originated from the recurrent laryngeal nerve is discussed. Histopathological photomicrographs and a CT scan are presented.

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Ansa Cervicalis-to-Recurrent Laryngeal Nerve Anastomosis for Unilateral Vocal Fold Paralysis: Experience of a Single Institution

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940811700109 ◽

2008 ◽

Vol 117 (1) ◽

pp. 40-45 ◽

Cited By ~ 69

Author(s):

Robert R. Lorenz ◽

Ramon M. Esclamado ◽

Aysenur M. Teker ◽

Marshall Strome ◽

Joseph Scharpf ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Laryngeal Nerve ◽

Unilateral Vocal Fold Paralysis ◽

Single Institution ◽

Ansa Cervicalis ◽

Nerve Anastomosis

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Characteristics of the Voice Handicap Index for Patients With Unilateral Vocal Fold Paralysis Who Underwent Arytenoid Adduction

Journal of Voice ◽

10.1016/j.jvoice.2018.12.012 ◽

2020 ◽

Vol 34 (4) ◽

pp. 649.e1-649.e6 ◽

Cited By ~ 1

Author(s):

Kenichi Watanabe ◽

Takeshi Sato ◽

Yohei Honkura ◽

Ai Kawamoto-Hirano ◽

Kazutaka Kashima ◽

...

Keyword(s):

Vocal Fold ◽

Vocal Fold Paralysis ◽

Voice Handicap Index ◽

Unilateral Vocal Fold Paralysis ◽

Arytenoid Adduction ◽

The Voice

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Spontaneous regeneration of recurrent laryngeal nerve following long-term vocal fold paralysis in humans: Histologic evidence

The Laryngoscope ◽

10.1002/lary.21739 ◽

2011 ◽

Vol 121 (5) ◽

pp. 1035-1039 ◽

Cited By ~ 28

Author(s):

Donghui Chen ◽

Shicai Chen ◽

Wei Wang ◽

Chuansen Zhang ◽

Hongliang Zheng

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Laryngeal Nerve ◽

Histologic Evidence ◽

Spontaneous Regeneration

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Long-term efficacy of primary intraoperative recurrent laryngeal nerve reinnervation in the management of thyroidectomy-related unilateral vocal fold paralysis

Acta Oto-Laryngologica ◽

10.3109/00016489.2014.939301 ◽

2014 ◽

Vol 134 (11) ◽

pp. 1179-1184 ◽

Cited By ~ 9

Author(s):

Seung Won Lee ◽

Ki Nam Park ◽

Sol Kil Oh ◽

Chan-Hee Jung ◽

Ji-Oh Mok ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Laryngeal Nerve ◽

Unilateral Vocal Fold Paralysis ◽

Term Efficacy

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Morphometric Differences in the Recurrent Laryngeal Nerve in Patients with Vocal Fold Paralysis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419870829 ◽

2019 ◽

Vol 129 (1) ◽

pp. 32-38

Author(s):

Melissa R. Chao ◽

Katherine A. Howe ◽

Jennifer L. Pierce ◽

Amanda C. Stark ◽

Marshall E. Smith ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Fold ◽

Fiber Diameter ◽

Vocal Fold Paralysis ◽

Nerve Fibers ◽

Laryngeal Nerve ◽

Diameter Distribution ◽

Fiber Density ◽

G Ratio ◽

Diameter Distributions

Objectives: Injury to the recurrent laryngeal nerve (RLN), if severe enough, can result in vocal fold paralysis. Reinnervation surgery can improve patient outcomes, but previous studies have reported a negative correlation between time since onset of paralysis and surgical outcomes. The ability of the paralyzed nerve to serve as a conduit for donor nerve fibers may be a factor in the success of reinnervation; however, changes in RLN composition after paralysis have not been well studied. Therefore, we investigated the morphometric composition of explanted RLN sections from patients who had experienced vocal fold paralysis for varying length of times. Methods: Nine nerve sections from unilateral vocal fold paralysis (UVP) patients and seven control nerve sections were analyzed for morphometric parameters including fascicular area, fiber count, fiber density, fiber packing, mean g-ratio, and fiber diameter distribution. Nerves from UVP patients were also compared as a function of time since UVP onset. Results: In comparison to control nerves, paralyzed nerves were found to have significantly lower fiber densities and fiber packing, higher mean g-ratio values, and a shift in diameter distributions toward smaller diameter fibers. With respect to paralysis duration, no significant differences were observed except in fiber diameter distributions, where those with paralysis for >2 years had distributions that were significantly shifted toward smaller diameter fibers. Conclusions: The morphometric data presented here suggest that correlations between the time since onset of vocal fold paralysis and reinnervation outcomes may be due to fiber size changes in the paralyzed nerve over time.

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