Neonatal Vocal Cord Paralysis Following Extracorporeal Membrane Oxygenation

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 793-796 ◽  
Author(s):  
Robert E. Schumacher ◽  
Irvin J. Weinfeld ◽  
Robert H. Bartlett
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Membrane Oxygenation ◽  
The Right ◽  
Unilateral Vocal Cord Paralysis

Five cases of unilateral vocal cord paralysis/ paresis were diagnosed following extracorporeal membrane oxygenation for newborn respiratory failure. All were right sided and transient in nature. None of the five patients had other findings commonly associated with vocal cord palsy. The extracorporeal membrane oxygenation procedure requires surgical dissection in the carotid sheath on the right side of the neck, an area immediately adjacent to both the vagus and recurrent laryngeal nerve. It is speculated that vocal cord paralysis in these infants was acquired as a result of the extracorporeal membrane oxygenation cannulation. Although the vocal cord paralysis resolved in all cases, two patients had difficult courses after extracorporeal membrane oxygenation. Therefore, laryngoscopic examination should be considered for patients after extracorporeal membrane oxygenation.

scholarly journals Strumos chirurginio gydymo pavojai: pooperacinis balso klosčių paralyžius

2006 ◽  
Vol 4 (2) ◽  
pp. 0-0
Author(s):  
Algimantas Žindžius ◽  
Virgilijus KKrasauskas ◽  
Jelena Jončiauskienė
Keyword(s):  
Surgical Treatment ◽  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Vocal Cord Palsy ◽  
Early Postoperative Period ◽  
Laryngeal Nerve ◽  
Vocal Cords

Algimantas Žindžius, Virgilijus kKrasauskas, Jelena JončiauskienėKauno medicinos universiteto Chirurgijos klinikaEivenių g. 2, LT-50009 Kaunas Tikslas Retrospektyviuoju tyrimu, remiantis medicininės dokumentacijos duomenų analize, įvertinti toksinės ir netoksinės strumos chirurginio gydymo pavojus, pooperacinio balso klosčių paralyžiaus rizikos veiksnius, nustatyti ir palyginti šios komplikacijos dažnumą, atsižvelgiant į operacijos indikacijas, apimtį ir metodiką. Ligoniai ir metodai Išnagrinėtos ligos istorijos 5555 pacientų, operuotų Kauno medicinos universiteto klinikų Chirurgijos klinikoje 1998–2004 metais. Skydliaukės operacijos atliktos subfascine ir atvirąja metodika, neidentifikuojant arba identifikuojant grįžtamuosius gerklų nervus. Rezultatai Pooperacinis balso klosčių paralyžius ištiko 127 (2,29%) pacientus: vienos balso klostės klostės – 104 (1,87%), abipusis – 23 (0,41%) pacientus. Po 350 operacijų nuo strumos recidyvo balso klosčių paralyžius pasireiškė 25 (7,14%) pacientams: 16 (4,57%) – vienpusis, 9 (2,57%) – abipusis. Nustatyta, kad chirurginis gydymas pritaikytas įvairioms strumos klinikinėms formoms, skyrėsi tik laikotarpiu, kai į gydymą įsitraukė chirurgai. Išvados Dažniausia skydliaukės operacija yra tiroidektomija (42,11%), dažniausia komplikacija – pooperacinis balso klosčių paralyžius (2,29%). Grįžtamojo gerklų nervo sužalojimus lemia įvairūs veiksniai – strumos patologinė morfologija, ligos recidyvas, ilgalaikis medikamentinis gydymas, nepalankūs skydliaukės ir gretimų struktūrų anatomijos variantai, operacijos apimtis, operacijos metodas. Dėl abipusio balso klosčių paralyžiaus ankstyvuoju pooperaciniu laikotarpiu 4 pacientams kilus kvėpavimo nepakankamumui, tracheostomijos buvo išvengta atlikus vienos balso klostės šoninę fiksaciją. . Reikšminiai žodžiai: struma, chirurginis gydymas, grįžtamojo gerklų nervo pažeidimas, balso klosčių paralyžius Dangers of thyroid surgery: postoperative paralysis of vocal cords Algimantas Žindžius, Virgilijus kKrasauskas, Jelena JončiauskienėKaunas University of Medicine, Surgery Clinic,Eivenių g. 2, LT-50009 Kaunas, Lithuania  Objective The aim of this article is to evaluate retrospectively dangers of the surgical treatment of toxic and nontoxic goiter. We also analyzed the risk factors of postoperative vocal cord paralysis, evaluated and compared the frequency of this complication depending on the indications, extent and methods of surgery. Patients and methods Three thousand eight hundred ninety seven operations on the thyroid were performed at the Clinic of Surgery of Kaunas University of Medicine Hospital during the period 1998–2002. The operations on the thyroid gland have been performed by subfascial and open methods, identifying the recurrent laryngeal nerves. Results Postoperative vocal cord paralysis developed in 97 (2.49%) cases. One-sided vocal cord palsy developed in 81 (2.08%) patients and bilateral in 16 (0.41%) patients. There were 19 (7.49%) cases of vocal cord palsy after 256 operations performed due to recurrent goiter, 13 being one-sided and 6 bilateral. It has been found that surgical treatment is suitable for all clinical forms of goiter, the only difference being the time the surgeons enter the process of treatment. Conclusions The most frequent thyroid gland operation is thyroidectomy (35.69%) and the most frequent complication is postoperative vocal cord paralysis (2.49%). The injuries to the recurrent laryngeal nerve are determined by both objective (thyroid gland pathology, thyroid cancer, recurrence of goiter, long-lasting medical treatment, unfavorable variants of thyroid gland and adjacent anatomic structures and the extent of operation) and subjective factors (methods of operation, surgeon’s experience, operative technique). Individual selection of open or subfascial methods of thyroid operation gives hope to reduce the complications of the surgical treatment. The respiratory insufficiency developing in the early postoperative period due to bilateral vocal cord paralysis can be cured by performing vocal cord laterofixation instead of tracheostomy. Key words: goiter, surgical treatment, recurrent laryngeal nerve palsy, paralysis of vocal cords

scholarly journals Prospective analysis of type I thyroplasty using gore-tex implant

2017 ◽  
Vol 3 (2) ◽  
pp. 276
Author(s):  
Sanjeev Mohanty ◽  
Sreenivas . ◽  
Vinay Raj T. ◽  
Devipriya . ◽  
Vinoth M.
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Vocal Cord Palsy ◽  
Post Treatment ◽  
Type I ◽  
Self Assessment ◽  
Maximum Phonation Time ◽  
Number Of Factors ◽  
Treatment Objective ◽  
Unilateral Vocal Cord Paralysis

<p class="abstract"><strong>Background:</strong> Vocal cord paralysis is a clinical sign caused by paralysis of intrinsic muscles of larynx due to dysfunction of recurrent laryngeal nerve. There are several methods available surgically for the medialisation of the abducted vocal cord. One of the common effective modality is the Gore-Tex medialisation thyroplasty. The results depend on a number of factors including the surgical expertise and extrusion of the Gore –Tex implant. This study is aimed at analysis of all Gore-Tex medialisation thyroplasty done at our centre. Prospectively asses and analyze the vocal outcomes and quality of life of patients in type 1 medialisation thyroplasty using Gore-Tex implant.</p><p class="abstract"><strong>Methods:</strong> Prospective study of 48 months on 30 patients with unilateral vocal cord paralysis.  Surgical procedure for the patients was standardized by using Gore-Tex implant to medialize the cord. Video-Laryngoscopy at end of 1<sup>st</sup> month and stroboscopy &amp; voice analysis at end of 3<sup>rd</sup> month post treatment, the parameters used for the pre and post treatment objective analysis are a) stroboscopic analysis, b) psychoacoustic evaluation, c) maximum phonation time, d) patient’s self-assessment.  </p><p class="abstract"><strong>Results:</strong> In our study of 30 patients with a follow up period of 48 months, we can conclude as follows – a)unilateral vocal cord paralysis does not have age or gender specificity, b)statistically significant vocal cord palsy affects the left side more by 70%, c)post op Gore-tex medialisation thyroplasty showed a statistically highly significant improvement in psychoacoustic, mean phonation time, d)post op Gore-Tex medialisation thyroplasty showed a statistically significant improvement in videostroboscopic analysis.</p><p><strong>Conclusions:</strong> Psycho acoustic, mean phonation time analysis would complement each other in the assessment of the medialisation thyroplasty thus obviating videostroboscopy.</p>

Respiratory failure of two sp gastric bypass patients and subsequent rescue with extracorporeal membrane oxygenation

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 73-76 ◽  
Author(s):  
L B Mongero ◽  
J R Beck ◽  
K A Charette ◽  
A Stewart
Keyword(s):  
Gastric Bypass ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Weight Loss Surgery ◽  
Gastric Bypass Surgery ◽  
Femoral Vein ◽  
Gastrointestinal Surgery ◽  
Membrane Oxygenation ◽  
Post Surgery ◽  
The Right

Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Gastrointestinal surgery for obesity (bariatric surgery) alters the digestive process by either restrictive surgical alterations or malabsorptive operations. Some 10 - 20% of patients who have weight-loss surgery require follow-up operations to correct complications. Hypoxemia after gastric bypass surgery for morbid obesity, a reported complication, can occur as early as 24 h post surgery. Two patients presented with severe hypoxia and were placed on veno-venous extracorporeal membrane oxygenation (ECMO). Patient No. 1 had an obstruction of the alimentary limb of the gastric bypass due to suture adhesions, and patient No. 2 had an incarcerated diaphragmatic hernia. While on ECMO, ventilation using a protective strategy (60% FiO2, pressure-controlled ventilation inspiratory pressure (PCV) IP 25-27, positive end-expiratory pressure (PEEP) 10-14, permissive hyper-capnia) was employed. An inflow cannula to the level of the right atrium served as arterial outflow from the circuit to the patient, while the femoral vein served as venous inflow to the ECMO circuit. Although ECMO in adult respiratory failure is often used as the last resort due to serious associated adverse events, we report two patients with life-threatening complications from gastric bypass who were rescued, resuscitated to day 7, and uneventfully discharged from the hospital to home.

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.

Vocal Cord Paralysis Associated with Cystic Fibrosis

1987 ◽  
Vol 96 (6) ◽  
pp. 680-683 ◽  
Author(s):  
Robert P. Zitsch ◽  
James S. Reilly
Keyword(s):  
Cystic Fibrosis ◽  
Pulmonary Artery ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Recurrent Laryngeal Nerve Injury ◽  
Pulmonary Artery Hypertension ◽  
Laryngeal Nerve ◽  
Close Proximity ◽  
Great Vessels

The course of the left recurrent laryngeal nerve through the chest brings it in close proximity with the heart and great cardiac vessels. Diseases of the heart and the great vessels are known to cause vocal cord paralysis, probably by mechanical injury to the recurrent laryngeal nerve. Pulmonary artery hypertension and dilation occur in up to 80% of patients with cystic fibrosis. We report a case of a 23-year-old woman with cystic fibrosis and left vocal cord paralysis. We believe that sudden pulmonary artery expansion produced recurrent laryngeal nerve injury and vocal cord paralysis. This is only the second association of unilateral vocal cord paralysis and cystic fibrosis in the medical literature. The pathophysiology of the cardiovocal syndrome is discussed.

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.

Sign in / Sign up

Export Citation Format

Share Document