Parapharyngeal abscess and vocal cord palsy caused by minor salivary gland sialadenitis: an atypical presentation treated using an endoscopic surgical approach

Parapharyngeal infections carry a significant risk of extensive suppuration and airway compromise. We report the case of a patient presenting with a right paranasopharyngeal abscess, featuring atypical symptoms that made diagnosis particularly challenging. Complications included evidence of right vocal cord paralysis, likely secondary to involvement of the vagus nerve. Notably, this paralysis occurred in isolation, without involvement of cranial nerves IX or XI, which would be expected from jugular foramen encroachment. Imaging demonstrated the presence of a collection extending towards the skull base, which was drained using a transnasal endoscopic approach, avoiding the use of external incisions. Tissue biopsies from the abscess wall suggest that the underlying aetiology was minor salivary gland sialadenitis, which has not been previously reported in the literature.

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Unilateral vocal cord palsy in a patient with jugular foramen schwannoma

10.12809/hkmj208791 ◽

2021 ◽

Vol 27 (4) ◽

pp. 303.e1-303.e2

Author(s):

WK Wong ◽

CY Cheng ◽

WC Cheng

Keyword(s):

Vocal Cord ◽

Vocal Cord Palsy ◽

Jugular Foramen

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Bilateral Vocal Cord Palsy following Interscalene Brachial Plexus Nerve Block

Anaesthesia and Intensive Care ◽

10.1177/0310057x0203000409 ◽

2002 ◽

Vol 30 (4) ◽

pp. 499-501 ◽

Cited By ~ 18

Author(s):

M. L. Plit ◽

P. N. Chhajed ◽

P. Macdonald ◽

I. E. Cole ◽

G. A. Harrison

Keyword(s):

Brachial Plexus ◽

Vocal Cord ◽

Brachial Plexus Block ◽

Significant Risk ◽

Vocal Cord Palsy ◽

Respiratory Complications ◽

Interscalene Brachial Plexus Block ◽

Plexus Block ◽

Hemi Arthroplasty

Acute respiratory complications of an interscalene brachial plexus block include ipsilateral phrenic nerve and recurrent laryngeal nerve palsies. A 71-year-old woman who had undergone a total thyroidectomy for papillary carcinoma 35 years ago was administered a right interscalene brachial plexus block for a shoulder hemi-arthroplasty. Subsequently she developed acute respiratory distress associated with marked stridor secondary to an acute right vocal cord palsy, which was superimposed on what was assumed to be a preexisting left-sided vocal cord palsy. On extubation the patient was noted to develop stridor again necessitating reintubation and tracheostomy was performed two weeks later. The vocal cord palsies failed to resolve over the subsequent 18-month follow-up. We describe this case to highlight the significant risk of this procedure in patients with preexisting or suspected contralateral vocal cord palsy.

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Intraoperative Mapping and Monitoring for Rootlets of the Lower Cranial Nerves Related to Vocal Cord Movement

Neurosurgery ◽

10.1227/neu.0000000000001109 ◽

2015 ◽

Vol 78 (6) ◽

pp. 829-834 ◽

Cited By ~ 3

Author(s):

Masahiko Wanibuchi ◽

Yukinori Akiyama ◽

Takeshi Mikami ◽

Katsuya Komatsu ◽

Toshiya Sugino ◽

...

Keyword(s):

Endotracheal Tube ◽

Vocal Cord ◽

Cranial Nerves ◽

Jugular Foramen ◽

Visual Signals ◽

Electromyographic Activity ◽

Intraoperative Mapping ◽

Lower Cranial Nerves ◽

Risk Of Aspiration ◽

Functional Preservation

Abstract BACKGROUND: Damage to the motor division of the lower cranial nerves that run into the jugular foramen leads to hoarseness, dysphagia, and the risk of aspiration pneumonia; therefore, its functional preservation during surgical procedures is important. Intraoperative mapping and monitoring of the motor rootlets at the cerebellomedullary cistern using endotracheal tube electrodes is a safe and effective procedure to prevent its injury. OBJECTIVE: To study the location of the somatic and autonomic motor fibers of the lower cranial nerves related to vocal cord movement. METHODS: Twenty-four patients with pathologies at the cerebellopontine lesion were studied. General anesthesia was maintained with fentanyl and propofol. A monopolar stimulator was used at amplitudes of 0.05 to 0.1 mA. Both acoustic and visual signals were displayed as vocalis muscle electromyographic activity using endotracheal tube surface electrodes. RESULTS: The average number of rootlets was 7.4 (range, 5-10); 75% of patients had 7 or 8 rootlets. As many as 6 rootlets (2-4 in most cases) were responsive in each patient. In 23 of the 24 patients, the responding rootlets congregated on the caudal side. The maximum electromyographic response was predominantly in the most caudal or second most caudal rootlet in 79%. CONCLUSION: The majority of motor fibers of the lower cranial nerves run through the caudal part of the rootlets at the cerebellomedullary cistern, and the maximal electromyographic response was elicited at the most caudal or second most caudal rootlet.

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