Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury

Abstract

Bilateral vocal cord paralysis is a serious illness requiring emergency intervention to resolve the potentially life-threatening respiratory distress. Several surgical procedures were proposed to help improve the airway and to eliminate the tracheostoma in those patients with permanent paralysis. All the procedures have their own advantages and disadvantages. We conducted a retrospective study of 30 patients affected by bilateral vocal cord paralysis following total thyroidectomy. All the patients underwent total thyroidectomy for benign thyroid pathology. In 26 patients (86.6%), cord paralysis occurred during the perioperative stage; and in the remaining 4 cases (13.3%), it occurred within the following 6 months. We treated all these bilateral recurrent laryngeal nerve paralysis patients with arytenoidectomy alone in 5 patients and arytenoidectomy with concomitant true and false posterior cordectomy in the remaining 25 patients. Twenty-four of the 25 patients who underwent the combined procedures (96%) reported subjective respiratory improvement and were decannulated within 60 days, being able to return to their normal daily activities. This study demonstrates that arytenoidectomy associated with posterior cordectomy is a satisfactory surgical treatment of bilateral vocal cord paralysis because it leads to a considerable and stable enlargement of the breathing space.

Complications after total thyroidectomy

“…The long-term treatment objective is to assure the patient a satisfactory quality of life with eventual removal of the tracheostomy and recovery of vocal and swallowing function. While spontaneous recovery of vocal cord mobility is unusual, recovery has been seen as late as 12 months after surgery [52]. Of the possible surgical remediations, arytenoidectomy with a posterior vocal cord resection restores space for air passage and respiratory function, at the price of more or less serious vocal sequelae and variable or transient aspiration during swallowing [52].…”

“…High-dose corticosteroid therapy is administered for 48 hours to decrease laryngeal edema (IV solumedrol 20 to 60 mg by slow IV infusion over 30 minutes every 8-12 hours, or dexamethasone 4 to 10 mg/day) [52]. Corticotherapy is accompanied by broad-spectrum antibiotic coverage and PPI medication, which seems to diminish the risk of laryngeal granuloma formation [52]. Removal of the endotracheal tube is performed in the operating room under laryngoscopic control.…”

Cordectomía posterior en el tratamiento de la parálisis bilateral de cuerdas vocales. ¿Debe ser la edad una limitación en su indicación?

“…Proporciona un corte seguro y limpio sin limitar la visibilidad del campo quirúrgico y produce una contracción del tejido remanente que permite una ampliación del espacio aéreo sin necesidad de extraer una mayor cantidad de tejido. Al tratarse de un procedimiento corto, con pocos riesgos y baja morbilidad asociada, puede repetirse en caso de resultados no satisfactorios, procediéndose a realizar un desbridamiento de la intervención previa realizada o completar una cordectomía bilateral algo menos agresiva en la cuerda vocal no intervenida en el primer procedimiento [3,13,26]. Esta fue la técnica realizada en uno de los pacientes de nuestra serie obteniéndose un buen resultado final (tasa de revisión del 6%, similar al del resto de series publicadas) [9][10][11][12][13][14][15][16][17].…”

Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy

“…For temporary bilateral RLN injury, the probability of providing tracheostomy as a temporary measure is assumed, very conservatively, to be 14·2 per cent. For permanent bilateral RLN injury, the probability of providing tracheostomy as a temporary measure until definitive surgery is 100 per cent. Permanent bilateral RLN injury is assumed to require arytenoidectomy as a definitive airway‐widening procedure.…”

“…For permanent bilateral RLN injury, the probability of providing tracheostomy as a temporary measure until definitive surgery is 100 per cent. Permanent bilateral RLN injury is assumed to require arytenoidectomy as a definitive airway‐widening procedure.…”