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Fulltext Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Misron K, Balasubramanian A, Mohamad I, Hassan NF

BMJ Case Rep, 2014;2014.

PMID: 24663247 DOI: 10.1136/bcr-2013-201033

Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.

Matched MeSH terms: Vocal Cord Paralysis/etiology*

Fulltext Delayed complication of radiotherapy: laryngeal fibrosis and bilateral vocal cord immobility

Prepageran N, Raman R

Med J Malaysia, 2005 Aug;60(3):377-8.

PMID: 16379198

Radiotherapy is the accepted treatment for early laryngeal carcinomas with the advantage of voice preservation. It is however, not without complications. We report a case of bilateral vocal cord immobility 15 years after radiotherapy. This appears to be due to ankylosis of cricoarytenoid joint and fibrosis of the larynx.

Matched MeSH terms: Vocal Cord Paralysis/etiology*

Chemo-port insertion: A cause of vocal cord palsy

Alazzawi S, Hindi K, Malik A, Wee CA, Prepageran N

Laryngoscope, 2015 Nov;125(11):2551-2.

PMID: 26108861 DOI: 10.1002/lary.25422

We describe extremely rare cases of vocal cord palsy following surgical insertion of a chemo port. Our cohort consisted of patients with cancer who developed hoarseness immediately after central venous line placement for the administration of chemotherapy, with vocal cord palsy confirmed with flexible laryngoscopy. Given the timing, central venous line placement appears to be the most likely cause.

Matched MeSH terms: Vocal Cord Paralysis/etiology*

Fulltext Proposal of integrated clinical pathway in the management of perioperative recurrent laryngeal nerve injury post thyroid and parathyroid surgery

Mahmud KA, Azman M, Muhammad R, Mat Baki M

Sci Rep, 2025 Feb 25;15(1):6811.

PMID: 40000673 DOI: 10.1038/s41598-025-86642-3

Early intervention is the current paradigm shift in the management of recurrent laryngeal nerve (RLN) injury post thyroidectomy and parathyroidectomy. Thus, an integrated clinical pathway is needed to enable early detection of RLN injury. A prospective longitudinal study was conducted from 2015 until 2021 in a single tertiary centre. A clinical pathway was developed where routine perioperative laryngeal assessments were implemented for all patients who underwent thyroidectomy and parathyroidectomy. Following an RLN injury, early surgical intervention was performed for unilateral vocal fold paralysis (UVFP). Data on patient demographics, risk factors, timing of RLN injury detection and type of intervention received were recorded in a proforma and analysed. 397 patients were included, involving 660 nerves at risk. The incidences of permanent RLN injury following thyroidectomy and parathyroidectomy were 5% and 1.8% respectively. The usage of intraoperative neuromonitoring was the only significant factor that affected the RLN injury according to multivariate analysis. 15% of RLN injuries were detected intraoperatively and 98% within two days. 70% of patients with UVFP received intervention in less than two weeks. The integrated clinical pathway has improved the validity of RLN injury incidence. It allows early detection of RLN injury and facilitates immediate intervention.

Matched MeSH terms: Vocal Cord Paralysis/etiology

Immediate selective laryngeal reinnervation in vagal paraganglioma patients

Mat Baki M, Clarke P, Birchall MA

J Laryngol Otol, 2018 Sep;132(9):846-851.

PMID: 30180919 DOI: 10.1017/S0022215118000476

OBJECTIVE: This prospective case series aimed to present the outcomes of immediate selective laryngeal reinnervation.

METHODS: Two middle-aged women with vagal paraganglioma undergoing an excision operation underwent immediate selective laryngeal reinnervation using the phrenic nerve and ansa cervicalis as the donor nerve. Multidimensional outcome measures were employed pre-operatively, and at 1, 6 and 12 months post-operatively.

RESULTS: The voice handicap index-10 score improved from 23 (patient 1) and 18 (patient 2) at 1 month post-operation, to 5 (patient 1) and 1 (patient 2) at 12 months. The Eating Assessment Tool 10 score improved from 20 (patient 1) and 24 (patient 2) at 1 month post-operation, to 3 (patient 1) and 1 (patient 2) at 12 months. There was slight vocal fold abduction observed in patient one and no obvious abduction in patient two.

CONCLUSION: Selective reinnervation is safe to perform following vagal paraganglioma excision conducted on the same side. Voice and swallowing improvements were demonstrated, but no significant vocal fold abduction was achieved.

Matched MeSH terms: Vocal Cord Paralysis/etiology

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