scholarly journals Medical Malpractice Trends in Thyroidectomies among General Surgeons and Otolaryngologists

OTO Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. 2473974X2092114 ◽  
Author(s):  
Megan L. Swonke ◽  
Nasim Shakibai ◽  
Mohamad R. Chaaban
Keyword(s):  
Informed Consent ◽  
High Risk ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
The United States ◽  
Signal Loss ◽  
Nerve Paralysis ◽  
General Surgeons ◽  
Training Of Surgeons

Objectives This study aims to examine litigation trends with thyroidectomies in the United States from 1984 to 2018. Methods We used the Westlaw legal database to collect data on the defendant, plaintiff, case demographics, alleged reasons for malpractice, additional complications, and case outcomes. Results The most common reason for litigation was vocal cord paralysis (51%, n = 28), with the majority ruling in favor of the defendant (64%, P = .042). Of those, 43% of cases (n = 12) were due to unilateral recurrent laryngeal nerve (RLN) injury, and 39% (n = 11) were due to bilateral RLN injury. Of the claims due to vocal cord paralysis that resulted in indemnity payment (36%), the majority included additional damages, such as lack of informed consent (30%) or subsequent damages from permanent tracheostomy (40%), which is usually a result of bilateral nerve paralysis. Conclusion RLN injury was the most common complication leading to trial, with most cases ruling in favor of the defense. However, most verdicts that favored the plaintiff or those that settled were due to subsequent damages from bilateral nerve paralysis, such as permanent tracheostomy. We encourage surgeons to consider a staged procedure in high-risk cases or cases with signal loss. There needs to be a bigger emphasis on informed consent in the training of surgeons. Surgeons should educate patients at high risk on potential surgical complications that may drastically affect their quality of life.

scholarly journals The quality of voice and speech before and after surgical treatment of bilateral recurrent laryngeal nerve paralysis

2017 ◽  
Vol 70 (5-6) ◽  
pp. 146-149
Author(s):  
Maja Bogdan ◽  
Rajko Jovic ◽  
Tanja Arbutina
Keyword(s):  
Surgical Treatment ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Bilateral Vocal Cord Paralysis ◽  
Nerve Paralysis ◽  
Quality Of Voice ◽  
Voice And Speech

Introduction. Bilateral recurrent laryngeal nerve paralysis usually occurs after thyroid surgery. In bilateral vocal cord paralysis, the voice is clear or slightly hoarse. The aim of this study was to determine whether the quality of voice and speech significantly deteriorates after the surgical treatment of bilateral recurrent laryngeal nerve paralysis. Material and Methods. The study included 16 patients with bilateral vocal cord paralysis and 16 age- and sex-matched healthy controls. The patients underwent partial arytenoidectomy with posterior cordectomy at the Clinical Center of Vojvodina in the period from January to April 2014. The quality of voice and speech was determined before and after surgical treatment by subjective, objective, aerodynamic voice analysis, and analysis of spontaneous speech, and then compared to the control group. Results. The results of this study showed that in patients with bilateral vocal cord paralysis the voice and speech quality was significantly worse compared to the healthy subjects. The results of subjective and aerodynamic analysis showed that there was a statistically significant deterioration in voice quality after the surgical treatment (p<0.05; p=0.001). The values of objective analysis and analysis of spontaneous speech parameters did not significantly change after the surgery (p>0.05; p=0.401). Conclusion. The patients with bilateral vocal cord paralysis have a poorer voice and speech quality compared to the healthy subjects. After the surgical treatment, patients presented with a lower voice quality, but there were no significant changes regarding the ability of spontaneous speech.

Recurrent Laryngeal Nerve Section for Spastic Dysphonia

1976 ◽  
Vol 85 (4) ◽  
pp. 451-459 ◽  
Author(s):  
Herbert H. Dedo
Keyword(s):  
Vocal Cord ◽  
Speech Therapy ◽  
Clinical Observation ◽  
Recurrent Nerve ◽  
Nerve Section ◽  
Nerve Paralysis ◽  
The Past ◽  
Vocal Quality ◽  
Recurrent Nerve Paralysis

Spastic dysphonia is a severe vocal disability in which a person speaks with excessively adducted vocal cords. The resulting weak phonation sounds tight, as if he were being strangled, and has also been described as laryngeal stutter. It is often accompanied by face and neck grimaces. In the past it has been regarded as psychoneurotic in origin and treated with speech therapy and psychotherapy with disappointing results. Because of laboratory and clinical observation that recurrent nerve paralysis retracts the involved vocal cord from the midline, it was proposed that deliberate section of the recurrent nerve would improve the vocal quality of patients with spastic dysphonia. In 34 patients the recurrent nerve was sectioned after Xylocaine® temporary paralysis showed significant improvement in vocal quality. Several patients have been advised against this operation because of the type of voice they developed with one vocal cord temporarily paralyzed. With nerve section plus postoperative speech therapy, approximately half of the patients have returned close to a “normal” but soft phonatory voice. The rest had varying degrees of improvement, but all, so far, have been pleased with the improvement in ease and quality of phonation and reduction or elimination of face and neck grimaces. Two men have a breathy component in their phonatory voices, and one woman has variable pitch.

PS01.189: A STUDY ON THE UTILITY OF INTRAOPERATIVE NEUROSTIMULATION MONITORING SYSTEM FOR RECURRENT LARYNGEAL NERVE IN ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 103-103
Author(s):  
Fumiaki Kawano ◽  
Shinsuke Takeno ◽  
Kousei Tashiro ◽  
Rouko Hamada ◽  
Yasuyuki Miyazaki ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Postoperative Management ◽  
Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Laryngeal Nerve Paralysis ◽  
Stimulation Of

Abstract Background Recurrent laryngeal nerve paralysis in esophagectomy is one of the most concerned complications. In recent years, intraoperative neurostimulation monitoring system (IONM) in thyroid surgery have been widespread for identification of recurrent laryngeal nerve and assessment of soundness. Therefore, IONM is often used during esophagectomy in Japan. In this study, we examined the efficacy of IONM in the patients undergoing esophagectomy. Methods Of 66 patients underwent esophagectomy since April 2015 until December 2017, IONM used in 27 patients in the surgery for the examination of recurrent nerve paralysis. We retrospectively reviewed these cases for intraoperative findings, neurostimulation monitoring findings and their outcomes. Results Of 27 patients, 25 were male and two were female, and the median age at operation was 66 years old. Although IONM was used in cervical lymph node dissection, there were no vocal cord responses in 5 patients (left side in 4 and right side in 1) with stimulation of the vagus nerve. Because all patients had no vocal cord paralysis due to stimulation of the cervical recurrent laryngeal nerve, it was diagnosed that there was the recurrent laryngeal nerve injury due to thoracic para recurrent nerve lymph node dissection. IONM was able to facilitate the identification and preservation of cervical recurrent nerve in all patients. Three out of 5 patients with no vocal cord response by IONM were confirmed recurrent laryngeal nerve paralysis in postoperative endoscope. In patients with vocal cord paralysis by IONM, it was possible to carefully performed postoperative management. On the other hand, in patients without paralysis, extubation on the operation day seemed possible without the concern for aspiration. Conclusion By using IONM in esophagectomy, we were able to evaluate the damage of the recurrent laryngeal nerve in real-time. Confirming the intraoperative recurrent nerve injuries is important for postoperative management or prediction of postoperative aspiration pneumonia. IONM in esophagectomy was useful not only in terms of surgical procedures but also in the evaluation of postoperative management. Disclosure All authors have declared no conflicts of interest.

scholarly journals Relationship of vocal cord paralysis to the coil diameter of vagus nerve stimulator leads

2015 ◽  
Vol 122 (3) ◽  
pp. 532-535 ◽  
Author(s):  
Leslie C. Robinson ◽  
Ken R. Winston
Keyword(s):  
Vagus Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Age Groups ◽  
The United States ◽  
Nerve Stimulator ◽  
Vagus Nerve Stimulator ◽  
Coil Diameter ◽  
Inner Diameter ◽  
Relationship Of

OBJECT This investigation was done to examine, following implantation of vagus nerve stimulators, the relationship of vocal cord paralysis to the inner diameter of the coils used to attach the stimulator lead to the nerve. Methods All data in this investigation were collected, as mandated by the FDA, by the manufacturer of vagus nerve stimulators and were made available without restrictions for analysis by the authors. The data reflect all initial device implantations in the United States for the period from 1997 through 2012. Results Vocal cord paralysis was reported in 193 of 51,882 implantations. In patients aged 18 years and older, the incidence of paralysis was 0.26% when the stimulator leads had coil diameters of 3 mm and 0.51% when the leads had 2-mm-diameter coils (p < 0.05). Across all age groups, the incidence of vocal cord paralysis increased with age at implantation for leads having 2-mm-diameter coils. Conclusions In patients aged 18 years and older, vocal cord paralysis occurred at almost twice the rate with the implantation of vagus nerve stimulator leads having 2-mm-diameter coils than with leads having 3-mm-diameter coils. The incidence of vocal cord paralysis increases with patient age at implantation.

Quality-of-Life Assessment in Patients with Unilateral Vocal Cord Paralysis

2001 ◽  
Vol 125 (3) ◽  
pp. 176-182 ◽  
Author(s):  
Brian C. Spector ◽  
James L. Netterville ◽  
Cheryl Billante ◽  
Janye Clary ◽  
Lou Reinisch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Life Assessment ◽  
Quality Of Life Assessment ◽  
Unilateral Vocal Cord Paralysis

Recurrent Laryngeal Nerve Paralysis during Transvenous Insertion of a Permanent Endocardial Pacemaker

1993 ◽  
Vol 102 (10) ◽  
pp. 810-813 ◽  
Author(s):  
Yuval Zohar ◽  
Nora Buller ◽  
Ytzhak Shvilly
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Medical Intervention ◽  
Sudden Onset ◽  
Laryngeal Nerve ◽  
Unusual Complication ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Nerve Lesion ◽  
Nerve Paralysis ◽  
Unilateral Vocal Cord Paralysis

We present 2 patients with sudden onset of dysphonia due to acute unilateral vocal cord paralysis that occurred during transvenous insertion of a permanent endocardial pacemaker. Acute paralysis of the vocal cord due to this kind of medical intervention is a very unusual complication that has been rarely reported. We believe that traumatic insertion of a pacemaker through the subclavian vein triggered a dynamic process that led to vocal cord paralysis. Three hypothetic explanations are presented: 1) a direct vagus nerve lesion, 2) a direct inferior laryngeal nerve lesion, and 3) a central nervous system lesion caused by a cerebral microembolus. Physicians should be aware of the possibility that associated acute paralysis of the vocal cord may occur after transvenous insertion of an endocardial pacemaker.

scholarly journals Vocal Cord Paralysis and Dysphagia as Sequelae of Gradenigo Syndrome

2018 ◽  
Vol 28 (1) ◽  
pp. 15-18
Author(s):  
Mary Ann V. Macasaet ◽  
Emmanuel Tadeus S. Cruz
Keyword(s):  
Vocal Cord ◽  
Otitis Media ◽  
Middle Ear ◽  
Vocal Cord Paralysis ◽  
Petrous Apex ◽  
Suppurative Otitis Media ◽  
Ear Infection ◽  
Nerve Paralysis ◽  
Middle Ear Infection ◽  
Petrous Apicitis

Objectives:     To present a case of vocal cord paralysis and dysphagia developing in Gradenigo syndrome and to discuss its clinical presentation, differential diagnosis and therapeutic approach.   Methods:             Design: Case Report             Setting:  Tertiary Government Hospital             Patient: One   Results:  A 54-year-old lady was admitted with a six month history of left-sided otorrhea, cheek and jaw pain, three months otalgia, and recent-onset hoarseness, dysphagia and diplopia on a background of mastoidectomy at age 6. Otoscopy revealed granulation tissue and chlolesteatoma occupying the left external auditory canal. There was left vocal cord paralysis with pooling of saliva in the pyriform sinus, left lateral gaze paralysis, and left facial nerve paralysis. CT scan revealed sclerosis of the left petrous apex and leptomeningeal enhancement on the left temporal lobe. Chronic suppurative otitis media with cholesteatoma and Gradenigo syndrome was diagnosed, and canal wall down mastoidectomy was performed Postoperatively, the otalgia and pain over the left jaw diminished in intensity while hoarseness and left lateral gaze palsy remained.   Conclusion: Gradenigo syndrome is known for its triad of retro-orbital pain, lateral gaze paralysis, and chronic middle ear infection due to petrous apicitis. Although rare, vocal cord paralysis and dysphagia may develop when infection traverses and encroaches on the jugular foramen where cranial nerves IX, X, and XI are lodged.  Knowledge of the syndrome should not be limited or confined to the classic triad.  Practicing ear specialists should be vigilant and cognizant of the clinical manifestations and sequelae of chronic middle ear infection. Prompt surgical intervention is crucial while resolution of the disease may vary for different individuals.   Keywords: Chronic otitis media, Gradenigo syndrome, vocal cord paralysis, petrous apicitis  

scholarly journals Enhancing Informed Consent for Physician Aid in Dying: Potential Role of Handout on Possible Benefits of Palliative Care

2017 ◽  
Vol 13 (10) ◽  
pp. e838-e843 ◽  
Author(s):  
Harry Peled ◽  
Kathleen E. Bickel ◽  
Christina Puchalski
Keyword(s):  
Palliative Care ◽  
Informed Consent ◽  
The United States ◽  
Patient Comprehension ◽  
Aid In Dying ◽  
Procedural Safeguard ◽  
Potential Benefits ◽  
Improve Patient

In the United States, physician aid in dying (PAD) is now legal in several states. However, neither a requirement for a palliative care (PC) consultation nor a defined education in PC exists for physicians participating in PAD or patients requesting assistance. Patients with advanced chronic and serious illness often experience complex physical, psychosocial, and spiritual distress. PC focuses on relieving this distress and improving patient quality of life through early identification and intervention in all domains of suffering, including physical, psychological, social, and spiritual. Ideally, we would recommend a PC consult, but unfortunately, PC is not readily available or offered at this time to all those who might benefit from it. We present a case for providing an educational handout to patients who inquire about PAD. This handout explains the potential benefits of PC as an additional procedural safeguard to existing regulations. Such information would help to ensure the integrity of the informed consent process, enhance shared decision making, and improve patient comprehension of the options.

scholarly journals Intraoperative nerve monitoring during thyroidectomy: evaluation of signal loss, prognostic value and surgical strategy

2019 ◽  
Vol 101 (8) ◽  
pp. 589-595
Author(s):  
EO Gür ◽  
M Haciyanli ◽  
S Karaisli ◽  
S Haciyanli ◽  
E Kamer ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Nerve Injury ◽  
Vocal Cord Paralysis ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Surgical Strategy ◽  
Signal Loss ◽  
Laryngeal Nerve Injury ◽  
Neural Monitoring

Introduction Intraoperative neural monitoring of the recurrent laryngeal nerve has been widely used to avoid nerve injury during thyroidectomy. We discuss the results of the change in surgical strategy after unilateral signal loss surgeries using intermittent intraoperative neural monitoring in a high-volume referral centre. Materials and methods Details of consecutive patients who underwent thyroidectomy with intermittent intraoperative neural monitoring between January 2014 and December 2017 were prospectively recorded and retrospectively reviewed. Loss of signal was defined as recurrent laryngeal nerve amplitude level lower than 100 μV during surgery. The rate of loss of signal and change in surgical strategy during the operation were evaluated. Results Loss of signal was detected in 25 (5.4%) of 456 patients for whom intermittent intraoperative neural monitoring was performed. Four patients had anatomic nerve disruption and surgery was completed by an experienced endocrine surgeon making use of intraoperative neural monitoring with continuous vagal stimulation. Staged thyroidectomy was performed on 16 patients with unilateral loss of signal in whom the nerves were intact visually. Postoperative vocal cord paralysis was encountered in 18 of 21 (85.7%) patients with loss of signal, and 16 of 18 (88.8%) were improved during the follow-up period. Patients’ voices were subjectively normal to the surgeon postoperatively in 9 of 21 (42.8%) patients who were found to have loss of signal with intact nerves. Conclusions Intraoperative neural monitoring can be used safely in thyroid surgery to avoid recurrent laryngeal nerve injury. It enables the surgeon to diagnose recurrent laryngeal nerve injury intraoperatively to estimate the postoperative nerve function and to modify the surgical strategy to avoid bilateral vocal cord paralysis.

Sign in / Sign up

Export Citation Format

Share Document