Vocal Fold Paralysis following the Anterior Approach to the Cervical Spine

1996 ◽  
Vol 105 (2) ◽  
pp. 85-91 ◽  
Author(s):  
James L. Netterville ◽  
Michael J. Koriwchak ◽  
Mark S. Courey ◽  
Mark Winkle ◽  
Robert H. Ossoff
Keyword(s):  
Cervical Spine ◽  
Vagus Nerve ◽  
Vocal Fold ◽  
Geometric Analysis ◽  
Vocal Fold Paralysis ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Recurrent Laryngeal Nerves ◽  
The Right ◽  
Lost To Follow Up

The anterior cervical approach is commonly used for access to the cervical spine. Vocal fold paralysis (VFP), a complication of this approach, is underrepresented in the literature. A review of the database of the Vanderbilt Voice Center revealed 289 patients with VFP, including 16 patients who developed paralysis as a result of an anterior cervical approach. The paralysis was on the right side in all but 1 patient. Compared to patients who developed VFP after thyroidectomy and carotid endarterectomy, patients with VFP after an anterior cervical approach have a higher incidence of aspiration and dysphagia, suggesting the presence of trauma to the superior laryngeal and pharyngeal branches as well as the recurrent branch of the vagus nerve. Two patients had partial return and 1 patient had complete return of vocal fold movement within 10 months. Of the remaining 13 patients, 8 underwent vocal fold medialization with improvement of symptoms. Two patients are 6 and 7 months postinjury and await vocal fold medialization. Two patients are 27 months and 45 months postinjury and are considering vocal fold medialization. The remaining patient was lost to follow-up. An anatomic-geometric analysis of the right and left recurrent laryngeal nerves was performed by using measurements obtained from computed tomography scans of 8 patients with idiopathic unilateral VFP, as well as experience gained through surgical and cadaveric dissections. We conclude 1) the anterior cervical approach may place multiple branches of the vagus nerve at risk; 2) because of anatomic-geometric factors, die right-sided anterior cervical approach may carry a greater risk to the ipsilateral recurrent laryngeal nerve than does the left; and 3) an understanding of the anatomy and geometry presented herein allows relatively safe exposure from either side of the neck.

Mesenchymal chondrosarcoma of the vagus nerve

2002 ◽  
Vol 116 (8) ◽  
pp. 644-646 ◽  
Author(s):  
W. Jamal ◽  
P. Rhys Evans ◽  
M. N. Sheppard
Keyword(s):  
Vagus Nerve ◽  
Current Literature ◽  
Vocal Fold ◽  
Malignant Neoplasm ◽  
Vocal Fold Paralysis ◽  
Mesenchymal Chondrosarcoma ◽  
Age Group ◽  
Clinicopathologic Features ◽  
The Right

Mesenchymal chondrosarcoma is a rare, aggressive, malignant neoplasm, which arises from extraskeletal sites in 30–40 per cent of cases. It is extremely rare in children. We present a novel case of childhood mesenchymal chondsarcoma arising from the vagus nerve in the neck, resulting in paralysis of the right vocal fold. The clinicopathologic features and management of this case are described along with a brief discussion on the aetiology of vocal fold paralysis in this age group. Current literature on extraskeletal presentation of mesenchymal chondrosarcoma is reviewed.

Iatrogenic Vocal Fold Paralysis: A Population-Based Cohort Study in Taiwan

2021 ◽  
pp. 000348942110412
Author(s):  
Ying-Ta Lai ◽  
Pin-Zhir Chao ◽  
Yu-Kang Chang ◽  
Yu-Chun Yen ◽  
Yu-Ting Shen ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cervical Spine ◽  
National Health Insurance ◽  
National Health ◽  
Vocal Fold ◽  
Population Based ◽  
Vocal Fold Paralysis ◽  
Research Database ◽  
Bilateral Vocal Fold Paralysis ◽  
Co Morbidity

Objective: Iatrogenic vocal fold paralysis is an important issue in laryngology, yet there are few population-based studies regarding the epidemiology. This study used a nationwide population-based claims database (the National Health Insurance Research Database) to investigate the epidemiology of iatrogenic unilateral and bilateral vocal fold paralysis (UVFP/BVFP) among the general adult population in Taiwan. Method: This study analyzed patients (20-90 years old) who underwent thyroid, parathyroid, thoracic, cardiac, or anterior cervical spine operations with vocal fold paralysis among adults in Taiwan from January 1, 2007 to December 31, 2013. The codes for vocal fold paralysis were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Claims data in the Taiwan National Health Insurance Research Database were used. Results: The most commonly performed operations which were related to vocal fold paralysis in Taiwan were, in descending order of frequency, thyroid, cervical spine, cardiac, thoracic (esophagectomy), and parathyroid operations. The operations that put laryngeal nerves at risk (ONRs) most commonly associated with a diagnosis of UVFP were, in descending order of frequency, thoracic, thyroid, parathyroid, cardiac, and cervical spine. For both UVFP and BVFP, the most commonly associated age group was 51 to 60. For both UVFP and BVFP, the more commonly associated sex was women. Increased length of stay was associated with a higher incidence of UVFP and BVFP. Charlson medical co-morbidity index (CCI) was not associated with UVFP but BVFP was associated with higher Charlson medical co-morbidity scores. Conclusions: Thyroid operations, age 51 to 60, longer hospital stays are associated with vocal fold paralysis. Overall women are more surgically affected than men. This is the first population-based study of iatrogenic vocal fold paralysis.

ANTERIOR CERVICAL APPROACH FOR THE TREATMENT OF CERVICAL MYELOPATHY

Neurosurgery ◽  
2007 ◽  
Vol 60 (suppl_1) ◽  
pp. S1-64-S1-70 ◽  
Author(s):  
Paul G. Matz ◽  
Patrick R. Pritchard ◽  
Mark N. Hadley
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Surgical Technique ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Clinical Symptoms ◽  
Recovery Of Function ◽  
Surgical Decompression ◽  
Cervical Approach ◽  
Anterior Cervical Approach

Abstract COMPRESSION OF THE spinal cord by the degenerating cervical spine tends to lead to progressive clinical symptoms over a variable period of time. Surgical decompression can stop this process and lead to recovery of function. The choice of surgical technique depends on what is causing the compression of the spinal cord. This article reviews the symptoms and assessment for cervical spondylotic myelopathy (clinically evident compression of the spinal cord) and discusses the indications for decompression of the spinal cord anteriorly.

Vocal fold paralysis following carotid endarterectomy

1999 ◽  
Vol 113 (5) ◽  
pp. 439-441 ◽  
Author(s):  
Fernanda I. Espinoza ◽  
Fiona B. MacGregor ◽  
Julie C. Doughty ◽  
Lynn D. Cooke
Keyword(s):  
Vagus Nerve ◽  
Carotid Endarterectomy ◽  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Indirect Laryngoscopy ◽  
One Year ◽  
Operative Assessment

AbstractInjury to the vagus nerve or one of its branches during carotid endarterectomy (CEA) can result in vocal fold paralysis (VFP). This study assessed prospectively 73 patients undergoing CEA. A total of 76 procedures were performed in these patients over a one-year period. All patients underwent preoperative and post-operative assessment of vocal fold mobility by indirect laryngoscopy and/or flexible nasendoscopy. All patients had normal vocal fold mobility pre-operatively. Eight patients (10 per cent) complained of hoarseness after surgery and in three patients (four per cent) examination confirmed an ipsilateral VFP. This persists in all three patients at six-month follow-up. Vocal fold assessment is important in patients undergoing CEA, particularly when performing second side surgery. We recommend that patients should be informed of the risk of VFP following CEA when obtaining consent.

scholarly journals Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

2013 ◽  
Vol 22 (12) ◽  
pp. 2850-2856 ◽  
Author(s):  
Hiroyuki Tanahashi ◽  
Kei Miyamoto ◽  
Akira Hioki ◽  
Nobuki Iinuma ◽  
Takatoshi Ohno ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Axial Curvature

Characteristic travelling patterns of non-recurrent laryngeal nerves

2014 ◽  
Vol 128 (6) ◽  
pp. 534-539 ◽  
Author(s):  
K H Hong ◽  
H T Park ◽  
Y S Yang
Keyword(s):  
Computed Tomography ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Vocal Fold ◽  
Laryngeal Nerve ◽  
New Classification ◽  
Laryngeal Nerves ◽  
Brachiocephalic Trunk ◽  
Recurrent Laryngeal Nerves ◽  
The Right

AbstractBackground:The non-recurrent laryngeal nerve is subject to potential injury during thyroid surgery. Intra-operative identification and preservation of this nerve can be challenging. Its presence is associated with an aberrant subclavian artery and the developmental absence of the brachiocephalic trunk. This study aimed to evaluate the incidence of non-recurrent laryngeal nerves and present a new classification system for the course of these nerves.Methods:Non-recurrent laryngeal nerves were identified on the right side in 15 patients who underwent thyroidectomy. The incidence of non-recurrent laryngeal nerves (during thyroidectomy) and aberrant subclavian arteries (using neck computed tomography) was evaluated, and the course of the nerves was classified according to their travelling patterns.Results:The overall incidence of non-recurrent laryngeal nerves was 0.68 per cent. The travelling patterns of the nerves could be classified as: descending (33 per cent), vertical (27 per cent), ascending (20 per cent) or V-shaped (20 per cent).Conclusion:Clinicians need to be aware of these variations to avoid non-recurrent laryngeal nerve damage. A retroesophageal subclavian artery (on neck computed tomography) virtually assures a non-recurrent laryngeal nerve. This information is important for preventing vocal fold paralysis. Following a review of non-recurrent laryngeal nerve travelling patterns, a new classification was devised.

scholarly journals The Application of Endoscopic Technique in High Cervical Anterior Approach to the Craniovertebral Junction

2020 ◽  
Author(s):  
Jiangtao Liu ◽  
Hongming Ji ◽  
Gangli Zhang ◽  
Shengli Chen ◽  
Shiyuan Zhang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Anterior Approach ◽  
Craniovertebral Junction ◽  
Close Proximity ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Surgical Corridor ◽  
High Cervical ◽  
Neurovascular Structures

Abstract Objectives: Surgery on the craniovertebral junction (CVJ) presents particular challenges owing to the close proximity of critical neurovascular structures and the brainstem. It is difficult for classic approaches to obtain the extra exposure of neurovascular structures of the CVJ in practice.The surgical approach to the craniovertebral junction (CVJ) offers specific challenges. We explored the feasibility of an endoscope-assisted high anterior cervical approach to the CVJ. Methods: We quantitatively assessed the surgical corridor to, and extent of exposure of, the CVJ in six cadaveric specimens, using 0° and 30° endoscopes. Results: The endoscope provided sufficient exposure of neurovascular structures and the brainstem in the CVJ. Resection of the anterior arch of C1 was avoided in minimal anterior clivectomy. After removing the odontoid, greater exposure of the CVJ was obtained. Conclusion: An endoscope-assisted high anterior cervical approach to the CVJ preserves cervical spine stability while minimizing the risk of neurovascular injury within the surgical corridor.

scholarly journals Result of the arc of movement of lower cervical spine after seven years of arthroplasty

2014 ◽  
Vol 13 (3) ◽  
pp. 185-187
Author(s):  
Luis Claudio de Velleca e Lima ◽  
Fernando Gritsch Sanchis
Keyword(s):  
Cervical Spine ◽  
Cervical Disc ◽  
Lower Cervical Spine ◽  
Lateral Bending ◽  
Disc Disease ◽  
Cervical Disc Replacement ◽  
The Right ◽  
Lost To Follow Up ◽  
Surgery Center

OBJECTIVE: To quantify the mobility of the lower cervical spine after seven years of total cervical disc replacement at two levels. METHOD: This clinical study was designed randomly and prospectively at the spine surgery center at the Hospital Nossa Senhora das Graças, in Canoas, RS-Brazil and at the Hospital Don João Becker, in Gravataí, RS-Brazil. Seventeen patients were included in the study that was designed to compare the data obtained from annual and sequential manner until the end of seven years. A comparison was made with the prior range of motion (ROM) of each patient. All patients were diagnosed with not tractable symptomatic cervical degenerative disc disease with two adjacent levels between C-3 and C-7. RESULTS: A total of patients underwent TDR in two levels and at the end of seven years, only one patient was lost to follow-up. The pre and postoperative ROM was the same in the first three years however after the fourth year there was a gradual decline with a loss of 12% of preoperative ROM in flexion, 21% in extension and 23% in the right and left lateral bending at the end of seven years. CONCLUSIONS: The clinical outcome of this study is evidence level IV in evaluating the ROM for Moby-C(r) for TDR in two adjacent levels at the lower cervical spine. These results show that the ROM is maintained during the first three years, gradually declining after that.

Benign disease of the thyroid gland and vocal fold paralysis

1999 ◽  
Vol 113 (5) ◽  
pp. 473-474 ◽  
Author(s):  
Bassam Abboud ◽  
Bassam Tabchy ◽  
Sélim Jambart ◽  
Walid Abou Hamad ◽  
Pierre Farah
Keyword(s):  
Vocal Fold ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Vocal Fold Paralysis ◽  
Benign Disease ◽  
Laryngeal Nerve ◽  
Multinodular Goitre ◽  
Surgical Exploration ◽  
Recurrent Laryngeal Nerves ◽  
Fair Chance

AbstractDevelopment of vocal fold paralysis in the presence of thyroid disease is strongly indicative of thyroid cancer, and requires surgical exploration. At the same time, vocal fold paralysis does not relieve the surgeon of his obligation to identify and preserve the recurrent laryngeal nerves, since the cause of the paralysis may be a benign disease, with a fair chance of functional recovery after surgery. We hereby report a case of recurrent laryngeal nerve palsy secondary to a multinodular goitre.

scholarly journals Laser Partial Arytenoidectomy as an Office Procedure

2019 ◽  
Vol 98 (4) ◽  
pp. 217-219 ◽  
Author(s):  
Abdul-Latif Hamdan ◽  
Elie Khalifee ◽  
Hussein Jaffal ◽  
Pierre Richard Abi Akl
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Thulium Laser ◽  
Office Procedure ◽  
Safe Alternative ◽  
Vocal Process ◽  
Pulsed Mode ◽  
Bilateral Vocal Fold Paralysis ◽  
Airway Symptoms ◽  
The Right

Bilateral vocal fold paralysis is a disabling condition that results in airway symptoms, dysphonia, and sometimes difficulty swallowing. Various types of glottal widening procedures have been described in the literature, all of which are performed in the operating room under general anesthesia. The aim is to report laser partial arytenoidectomy as an office-based treatment modality in a patient with bilateral vocal fold paralysis. Using Thulium laser fiber introduced through the working channel of fiberoptic nasopharyngoscope, a posterior cordectomy followed by resection of the vocal process of the right arytenoid was performed. The laser was used in a pulsed mode, power range 3.5 to 4.5 W, duration 70 to 300 milliseconds, repetition 2 to 4 Hz, and aiming beam 65%. The procedure was well tolerated and the patient was successfully decannulated 3 weeks later. Unsedated office-based laser arytenoidectomy might be considered a safe alternative to the commonly practiced glottal widening procedures in patients with a preexisting tracheotomy.

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