Airway complication after thyroid surgery: Minimally invasive management of bilateral recurrent nerve injury

László Rovó, J. Jóri, Marek Brzózka, J. Czigner

Research output: Article

30 Citations (Scopus)

Abstract

Objectives: After bilateral vocal cord paralysis, the consequent paramedian position usually necessitates tracheostomy for at least 6 months, when the paralysis is potentially reversible. In the present study a reversible endoscopic vocal cord laterofixation procedure was used instead of tracheotomy. Study Design: Prospective study of 15 consecutive patients aged 33 to 73 years who suffered bilateral recurrent laryngeal nerve paralysis after thyroid surgery. Methods: The operation was performed endoscopically with a special endo-extralaryngeal needle carrier instrument. Two ends of a monofilament nonresorbable thread were passed above and under the posterior third of the vocal cord and knotted on the prelaryngeal muscles, permitting the creation of an abducted vocal cord position. If movement of one or both vocal cords recovered, the suture was removed regular spirometric measurements and radiological aspiration tests were conducted on the patients. Results: During the follow-up period of 3 to 40 months, airway stability was demonstrated in all but one patient. After the repeated lateralization procedure, this patient's breathing improved. Partial or complete vocal cord recovery was observed in eight patients. In six patients further voice improvement was achieved when the threads were removed after vocal cord medialization or recovery. Mild postoperative aspirations ceased in the first postoperative days. Conclusions: This management approach offers an alternative to tracheostomy in the early period of paralysis, avoids terminal loss of voice quality, and provides a 'one-stage' solution for permanent bilateral recurrent nerve injuries.

Original languageEnglish
Pages (from-to)140-144
Number of pages5
JournalLaryngoscope
Volume110
Issue number1
Publication statusPublished - jan. 2000

Fingerprint

Minimally Invasive Surgical Procedures
Vocal Cords
Thyroid Gland
Wounds and Injuries
Vocal Cord Paralysis
Tracheostomy
Paralysis
Voice Quality
Recurrent Laryngeal Nerve
Tracheotomy
Sutures
Needles
Respiration
Prospective Studies
Muscles

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Airway complication after thyroid surgery : Minimally invasive management of bilateral recurrent nerve injury. / Rovó, László; Jóri, J.; Brzózka, Marek; Czigner, J.

In: Laryngoscope, Vol. 110, No. 1, 01.2000, p. 140-144.

Research output: Article

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abstract = "Objectives: After bilateral vocal cord paralysis, the consequent paramedian position usually necessitates tracheostomy for at least 6 months, when the paralysis is potentially reversible. In the present study a reversible endoscopic vocal cord laterofixation procedure was used instead of tracheotomy. Study Design: Prospective study of 15 consecutive patients aged 33 to 73 years who suffered bilateral recurrent laryngeal nerve paralysis after thyroid surgery. Methods: The operation was performed endoscopically with a special endo-extralaryngeal needle carrier instrument. Two ends of a monofilament nonresorbable thread were passed above and under the posterior third of the vocal cord and knotted on the prelaryngeal muscles, permitting the creation of an abducted vocal cord position. If movement of one or both vocal cords recovered, the suture was removed regular spirometric measurements and radiological aspiration tests were conducted on the patients. Results: During the follow-up period of 3 to 40 months, airway stability was demonstrated in all but one patient. After the repeated lateralization procedure, this patient's breathing improved. Partial or complete vocal cord recovery was observed in eight patients. In six patients further voice improvement was achieved when the threads were removed after vocal cord medialization or recovery. Mild postoperative aspirations ceased in the first postoperative days. Conclusions: This management approach offers an alternative to tracheostomy in the early period of paralysis, avoids terminal loss of voice quality, and provides a 'one-stage' solution for permanent bilateral recurrent nerve injuries.",
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AU - Czigner, J.

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AB - Objectives: After bilateral vocal cord paralysis, the consequent paramedian position usually necessitates tracheostomy for at least 6 months, when the paralysis is potentially reversible. In the present study a reversible endoscopic vocal cord laterofixation procedure was used instead of tracheotomy. Study Design: Prospective study of 15 consecutive patients aged 33 to 73 years who suffered bilateral recurrent laryngeal nerve paralysis after thyroid surgery. Methods: The operation was performed endoscopically with a special endo-extralaryngeal needle carrier instrument. Two ends of a monofilament nonresorbable thread were passed above and under the posterior third of the vocal cord and knotted on the prelaryngeal muscles, permitting the creation of an abducted vocal cord position. If movement of one or both vocal cords recovered, the suture was removed regular spirometric measurements and radiological aspiration tests were conducted on the patients. Results: During the follow-up period of 3 to 40 months, airway stability was demonstrated in all but one patient. After the repeated lateralization procedure, this patient's breathing improved. Partial or complete vocal cord recovery was observed in eight patients. In six patients further voice improvement was achieved when the threads were removed after vocal cord medialization or recovery. Mild postoperative aspirations ceased in the first postoperative days. Conclusions: This management approach offers an alternative to tracheostomy in the early period of paralysis, avoids terminal loss of voice quality, and provides a 'one-stage' solution for permanent bilateral recurrent nerve injuries.

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