Bilateral Internal Superior Laryngeal Nerve Palsy of Traumatic Cervical Injury Patient Who Presented as Loss of Cough Reflex after Anterior Cervical Discectomy with Fusion

Abstract

Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury.

Surgical treatment of bronchial asthma by resection of the laryngeal nerve

“…Injury to the unilateral SLN does not cause prompt, noticeable functional impairment of the vocal cords. The dual innervation of laryngeal mucosa from the contralateral SLN prevents loss of laryngeal sensation [ 22 ]. In our work, nerve resection was performed in all 41 cases with only from one side (unilateral).…”

A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population

“…Similarly, retropharyngeal hematomas may develop as a result of trauma and may also cause an individual to experience transient dysphagia. Spontaneous improvement in transient dysphagia was noted over time in all studies following placement of a feeding tube [11–14]. …”

“…Modified diet textures are thought to promote safe swallowing by slowing flow rate, and/or reducing the strength or effort required for effective swallowing [21]. Three of the four studies that discussed swallowing intervention reported the use of modified diets for individuals with traumatic spinal cord injury [11, 12, 14]. Diet textures were individualized as per each patient’s needs, and varied both for solids (soft or regular) and liquids (thin or thickened).…”

“…Shin, Sung, Nam, and Cho [14] presented the case of a 75 year old man who reported mild dysphagia following anterior cervical discectomy with fusion, performed after he had fallen while hiking. Videofluoroscopic examination showed silent aspiration on 3 cc boluses of thin and thick liquids.…”

“…Within this article set, dysphagia was often diagnosed based on the incidence of aspiration before, during, or following the swallow [13, 14]. Although aspiration can occur when an individual has dysphagia, it is not the only characteristic of a swallowing impairment.…”