Concomitant type I thyroplasty and thoracic operations for lung cancer: Preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury

Mom, T.; Filaire, Marc; Advenier, D; Guichard, Christophe; Naamee, Adel; Escande, G; Llompart, X.; Vallet, Laurent; Gabrillargues, Jean; Courtalhiac, Christophe; Claise, Béatrice; Gilain, L.

doi:10.1067/mtc.2001.112533

Cited by 42 publications

(21 citation statements)

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“…The thoracic procedures with highest risk of RLRN injury are esophagectomy and lung resections for malignancy, especially when radical mediastinal lymphadenectomy is performed [5]. RLRN lesions have also been reported after cardiovascular and neurosurgical procedures [7,12].…”

Section: Introductionmentioning

confidence: 98%

Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery

et al. 2012

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Section: Introductionmentioning

confidence: 98%

Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery

et al. 2012

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“…Timing of intervention should be a joint decision between the thoracic surgeon and otolaryngologist. Early medicalization can reduce pulmonary complications by reducing aspiration, improving cough and pulmonary toilet [51].…”

Section: Recurrent Laryngeal Nervementioning

confidence: 99%

Postlobectomy Early Complications

Ziarnik

Grogan

2015

Thoracic Surgery Clinics

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INTRODUCTIONThe most effective management of postoperative crises is prevention. This starts with preoperative preparation and patient screening. There are many factors that can be controlled and improved by the patient, including but not limited to, smoking cessation, cardiopulmonary rehab and teaching/setting peri-operative expectations. Equally as important is patient selection, which is influenced by pulmonary function tests, cardiopulmonary reserve, and pre-existing comorbidities. After the operation, the care team can also greatly improve outcomes with aggressive cardiopulmonary therapies, ambulation, vigilant monitoring and frequent assessments of the patient. Even when all of these guidelines are followed not all early complications can be avoided.A recent review of the National Cancer Database by Rosen et al found a 2.6% mortality from lobectomy [1]. Morbidity associated with lobectomy is 10% to 50%, and increases in the elderly [2]. The population being treated by thoracic surgeons continues to age and the complexity of the operations is increasing as neoadjuvant therapies become more prevalent. Early postoperative crises after lobectomy will occur, necessitating prompt and effective management strategies. The most common complications after pulmonary resection are listed below in Table 1, in this chapter we will focus on the early complications after lobectomy [3].For the purposes of this chapter we will define early post-operative crisis as those that develop within 48 hours of the operation. AIR LEAKProlonged air leak is the most common complication after pulmonary resection, with a reported incidence of 15-18% [4]. Prolonged air leak is defined as a leak lasted more than 7 days after pulmonary resection. Cerfolio et al reported an incidence of 25% on postoperative day 1 and 20% on postoperative day 2 [5,6] U.S. Department of Veterans AffairsPublic Access Author manuscript VA Author ManuscriptVA Author Manuscript VA Author Manuscript parenchymal air leaks post-operatively and a variety of factors that influence any given patients propensity for developing an air leak. Patient factors that increase risk of developing an air leak include emphysematous lungs, larger parenchymal resection and therefore less parenchymal apposition to chest wall, and inadequate drainage of air by thoracostomy tube(s). PREVENTION STRATEGIES1. Bronchial stump buttressing with a muscle flap. In patients with an infected pleural space or who are on chronic immunosuppression, coverage of the stump with vascularized muscle may prevent bronchial stump breakdown [7]. The intercostal muscle is an excellent coverage option and is harvested from the intercostal space upon entry into the chest at the level of the thoracotomy. It is important to plan ahead, as this muscle needs to be harvested prior to placing the rib spreader in an open operation to prevent crushing the vascular supply. Dissection is begun on the inferior rib and the muscle is mobilized using a periosteal elevator posteriorly to the paraspinous muscle. Attention is...

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“…Because of the minimally invasive character of injection laryngoplasty compared to techniques using external approaches, the risk of infection is expected to be lower. However, thyroplasty is the technique of choice in patients with very severe glottic insufficiency, as seen in lesions of the vagus nerve, because the paralyzed vocal cord is then fixed in a more lateral position [8].…”

Section: Discussionmentioning

confidence: 99%

The Use of Polydimethylsiloxane for Injection Laryngoplasty

Hagemann

Seifert

2008

World j. surg.

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Background Injuries of the recurrent laryngeal nerve with consecutive vocal cord paralysis is a typical complication in chest, esophageal, thyroideal, and neck surgery. Glottic insufficiency secondary to such a lesion can be treated by endolaryngeal vocal cord augmentation (injection laryngoplasty). Many different substances have been used, often showing complications or disadvantages. This study reports on the use of injectable polydimethylsiloxane (PDMS), with special regard to the long-term results. Methods In this prospective study, 21 patients with unilateral vocal cord paralysis underwent injection laryngoplasty using PDMS at a volume of 0.5-1.0 ml. Preoperatively, 6 weeks and 12 months after the injection the following parameters concerning patients' voice were evaluated: Glottic closure by videolaryngostroboscopy, maximum phonation time, voice range, voice dynamic, jitter, shimmer, noise-toharmonic-ratio, and roughness, breathiness, and hoarseness (RBH). In addition, patients were asked to give their own evaluation of how satisfied they felt with their voice and of the handicaps it caused them. Results Postoperatively an improvement was evident in all the parameters that were investigated, and this significant improvement was still in evidence for most of the parameters more than one year after the injection. In our study no complications were observed more than one year after injection. Conclusion PDMS is a safe substance for injection laryngoplasty in unilateral vocal cord paresis. Objective and subjective parameters confirm its effectiveness. It is suitable for obtaining satisfying results in the reestablishment of the patient's voice and communication ability.

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Concomitant type I thyroplasty and thoracic operations for lung cancer: Preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury

Cited by 42 publications

References 20 publications

Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery

Anatomical basis of the risk of injury to the right laryngeal recurrent nerve during thoracic surgery

Postlobectomy Early Complications

The Use of Polydimethylsiloxane for Injection Laryngoplasty

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