Rehabilitación del nervio recurrente laríngeo postiroidectomía / Recurrent laryngeal nerve rehabilitation after thyroidectomy

El carcinoma papilar tiroideo es el tipo de cáncer más común de esta glándula, y su tratamiento de elección es la tiroidectomía. Entre las complicaciones asociadas resalta la parálisis de las cuerdas vocales, la cual ocurre por una lesión directa del nervio laríngeo recurrente durante la cirugía. Se presenta una paciente de 22 años de edad con este diagnóstico, a la cual se le realizó una tiroidectomía total; en el postoperatorio inmediato la paciente comenzó con estridor laríngeo intenso que requirió una traqueotomía de urgencia. En el examen físico se constató una parálisis bilateral de las cuerdas vocales y se decidió comenzar un tratamiento de rehabilitación del nervio recurrente laríngeo con laserterapia y HIVAMAT-200 como modalidades combinadas. Los resultados alcanzados con la fisioterapia fueron satisfactorios y la paciente se reintegró rápidamente a su ámbito familiar, escolar y social.

Papillary thyroid carcinoma is the most common type of cancer of this gland, and its treatment of choice is thyroidectomy. Vocal cord paralysis stands out among the associated complications, in which a direct injury to the recurrent laryngeal nerve occurs during surgery. We present a 22-year-old female patient with this diagnosis, who underwent a total thyroidectomy; in the immediate postoperative period the patient began with intense laryngeal stridor requiring an emergency tracheotomy. Physical examination revealed bilateral vocal cord paralysis and it was decided to begin rehabilitation treatment of the recurrent laryngeal nerve with laser therapy and HIVAMAT-200 as combined modalities. The results achieved with physiotherapy were satisfactory and the patient was quickly reintegrated into her family, school and social environment.

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

Abstract Introduction Iatrogenic bilateral vocal fold immobility (BVFI) often arises from posterior glottic stenosis (PGS) after endotracheal intubation, whereby posterior commissure mucosal disruption leads to fibrosis and ankylosis of the cricoarytenoid joints. Sequelae can be devastating, resulting in dyspnea, stridor, and death due to asphyxiation. Objectives We sought to review features associated with PGS to better understand how to prevent this condition. A secondary aim is to analyze factors correlating to tracheostomy dependence. Methods Charts from January 2010 to November 2020 were retrospectively reviewed, and adult patients with the diagnosis of BVFI after intubation were included. Data on comorbidities, duration of intubation, laryngoscopy, and decannulation status was analyzed. Results Out of the 68 patients included in the present study, 60.3% were male, and the mean duration of intubation 14.3 ± 8.5 days. A total of 94% of the patients were intubated for at least 7 days, diabetic, and/or obese. Although association with prolonged intubation >7 days was not significant (p = 0.064), complete BVFI on fiberoptic exam (n = 47) was significantly associated with tracheostomy dependence both in the entire cohort (p = 0.036) and in the 56 patients with tracheostomy (p = 0.0086). Patients without cardiovascular disease (CVD) were less likely to be tracheostomy dependent compared with those with CVD (odds ratio [OR]: 0.23 [0.053-0.79]; p = 0.028). Conclusions We identified duration of intubation, DM, and obesity as potential risk factors for PGS. Complete immobility and CVD were significantly associated with tracheostomy dependence. Our findings may have important implications for earlier tracheostomy in high-risk intubated patients, as well as for closer monitoring of disease progression and earlier intervention in those predisposed to tracheostomy dependence.

El niño con estridor persistente / The child with persistent stridor

El estridor es un ruido respiratorio anormal generado por obstrucción o colapso de la vía aérea laringotraqueal, de manera aguda o de evolución crónica. Existen distintas causas tanto congénitas como adquiridas capaces de producir dificultad respiratoria, que puede llegar a ser grave y con potencial riesgo vital. El diagnóstico clínico del paciente con estridor persistente debe ser complementado con un estudio endoscópico de la vía aérea y en ocasiones con imágenes, para intentar determinar el o los sitios comprometidos y posibles malformaciones asociadas. La indicación de tratamiento debe ser individualizada, considerando el estado general del paciente, las etiologías responsables, el im pacto sobre la respiración y la deglución, el pronóstico y la capacidad técnica del equipo tratante, entre otras. Las alternativas pueden incluir observación, medidas no farmacológicas, medicamentos locales o sistémicos, procedimientos endoscópicos, cirugías abiertas, o bien la instalación de una traqueostomía de manera temporal o como manejo definitivo. El objetivo de esta revisión es entregar un adecuado conocimiento de la fisiopatología y la etiopatogenia del estridor pediátrico persistente, fundamental para el correcto manejo de estos pacientes complejos, que debiera realizarse idealmente en un contexto multidisciplinario.

Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both congenital and acquired, that can produce shortness of breath which may be severe and potentially life-threatening. The clini cal diagnosis must be complemented with an endoscopic airway assessment and sometimes with imaging, to try to determine the areas involved and possible associated malformations. Treatment should be individualized, considering the patient's overall condition, stridor etiology, its impact on breathing and swallowing, prognosis, and technical capacity of the managing team, among others. Alternatives may include observation, non-pharmacological measures, local or systemic medications, endoscopic and open surgeries, or a temporary or long-term tracheostomy. A thorough understan ding of the pathophysiology and etiopathogenesis of persistent pediatric stridor is essential for the correct management of these complex patients, ideally in a multidisciplinary manner.

Síndrome de Tapia posterior a cirugía nasal

Resumen El síndrome de Tapia es una complicación poco frecuente secundaria a la manipulación de la vía aérea. Se caracteriza por haber una lesión concomitante de los pareas craneales X (nervio vago) y XII (nervio hipogloso), usualmente por compresión o sobredistensión de estos. Inicialmente puede hacernos sospechar una lesión central, al haber compromiso de dos nervios craneales bajos en forma simultánea, pero la gran mayoría de los casos descritos son lesiones periféricas. De los procedimientos asociados a esta complicación, los que lideran en frecuencia son los de cabeza y cuello, por lo que es de gran importancia tenerlo en conocimiento en el desarrollo de nuestra práctica clínica. Nuestro paciente presentó esta complicación tras una septoplastía con turbinectomía sin complicaciones en el sitio operatorio, ni anestésicas. Se manejó con fonoaudiología y corticoides orales, con recuperación completa a los cuatro meses de posoperatorio.

Abstract Tapia's Syndrome is a rare complication secondary to airway manipulation. It is characterized by a concurrent lesion of cranial nerve pairs X (vagus nerve) and XII (hypoglossal nerve), usually attributed to compression or stretching of these nerves. Initially, it may lead us to suspect a central lesion, as there is simultaneous involvement of two low cranial nerves, but the vast majority of cases described are peripheral lesions. The procedures most frequently associated with this complication are head and neck surgery, which is why it is very important to bear this in mind in the development of our clinical practice. Our patient showed Tapia's syndrome following septoplasty with turbinectomy without complications in the operative site nor under anesthesia. He was treated with phoniatric and oral corticoids, recovering completely four months after surgery.

Resultados polisomnográficos de pacientes adultos con parálisis de cuerdas vocales y diagnóstico de síndrome de apnea hipopnea obstructiva del sueño llevados a cordectomía posterior: estudio antes-después / Polisomnographic results of adult patients with bilateral vocal cord paralysis and diagnosis of hypopnea sleep apnea syndrome managed with posterior cordectomy: study before-after

Introducción: la parálisis bilateral de cuerdas vocales (PBCV) y el síndrome de apnea hipoapnea obstructiva del sueño (SAHOS) son patologías que generan limitación respiratoria. Por tratarse de patologías obstructivas, es razonable considerar una posible relación. Materiales y métodos: se realizó un estudio antes y después en dos centros universitarios de Bogotá. Se describieron frecuencias y medidas de tendencia central. Se utilizaron las pruebas de McNemar BoWker y T pareada o Wilcoxon, considerándose significativo un p <0,05. Resultados: se incluyeron 14 pacientes con PBCV manejados con cordectomía posterior transversa. 100 % fueron del género femenino y la media de edad de 51,2±10,73 años. El promedio de índice de masa corporal (IMC) fue 25,42±5,4, 50 % tuvieron IMC normal. La severidad del SAHOS fue leve (42,9 %), moderada (28,6 %) y severa (28,6 %). La intervención fue exitosa en un 64,28 %, lo que evidencia una reducción del 54 % del índice apnea/hipopnea (IAH) prequirúrgico comparado con el posquirúrgico (p = 0,029), 85,6 % reducción en el índice de apneas obstructivas (p = 0,017), en el índice de hipopneas en 52 % (p = 0,028) y la latencia del sueño en 33,3 % (p = 0,025). Otras variables no mostraron diferencias significativas (p >0,05). Conclusiones e importancia clínica: los resultados descritos evidencian una relación estadísticamente significativa del SAHOS y la PBCV. Los pacientes con PBCV se beneficiaron del uso de la cordectomía posterior como intervención terapéutica ya que disminuye los índices de severidad del SAHOS y, por ende, mejora la calidad de vida de los pacientes.

Background: bilateral vocal cord paralysis (BVFP) and obstructive sleep apnea-hypopnea syndrome (OSAHS) are pathologies that generate respiratory limitation. As they are obstructive airway diseases, it is reasonable to consider a possible relationship. Materials and methods: a before and after study was performed, in two university centers in Bogotá, frequencies and measures of central tendency were described. The McNemar BoWker and paired T or Wilcoxon tests were used, considering p <0.05 significant. Results: 14 patients were managed with transverse posterior cordectomy. 100 % were female and the mean age of 51.2±10.73 years. The average BMI was 25.42±5.4, 50 % had normal BMI. OSAHS severity was mild 42.9 %, moderate 28.6 % and severe 28.6 % disease classification. The intervention was successful in 64.28 %, there was a 54 % reduction in presurgical Apnea Hypopnea Index compared to the post-surgical one (p = 0.029), 85.6 % reduction in the index of obstructive apneas (p = 0.017), in the index of hypopneas in 52 % (p = 0.028) and sleep latency in 33.3 % (p = 0.025). Other variables showed no significant differences (p >0.05). Conclusions: the results described show a statistically significant relationship between OSAHS and BVFP. Patients with BVFP benefited from the use of posterior cordectomy as a therapeutic intervention reducing the severity rates of OSAHS and thus improving the quality of life of patients.

Ortner's syndrome

Inferior laryngeal nerve palsy is a relatively common entity. Nevertheless, an occurrence as a result of a cardiovascular pathology is rare. In this case, it is called Ortner's syndrome (OS). Aortic diseases are responsible for more than half of cases. Supraaortic vessels disorders are rare causes of OS. In our new report, a non-smoker and non-drinker 70-year-old woman presented with a history of dysphonia since childhood. On direct laryngoscopy, a left vocal cord paralysis was detected and a contrast-enhanced computed tomography showed an aberrant right subclavian artery originating from the left portion of the aortic arch. Its course to its usual site runs behind the esophagus, being also called arteria lusoria. In this particular case, two unusual situations appear together, which contributes to the rarity of the event.(AU)

Value of pathogenic diagnosis of 18F-FDG PET/CT imaging in non-traumatic unilateral vocal cord paralysis / 中华核医学与分子影像杂志

Objective@#To evaluate the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging in non-traumatic unilateral vocal cord paralysis (UVCP) and compare the radioactive uptake in different lesions.@*Methods@#Clinical data of 62 patients (49 males, 13 females; age: (61.7±12.8) years) with non-traumatic UVCP (43 cases of left vocal cord paralysis and 19 cases of right) admitted to Ji′an Hospital from January 2016 to December 2018 were analyzed retrospectively. Pathological results, imaging or follow-up results were considered as the standard of final diagnosis. The diagnostic efficacy of PET/CT imaging for the primary cause was analyzed. The maximum standardized uptake values (SUVmax) of vocal cord in patients with different etiology were compared by independent-sample t test.@*Results@#According to the final diagnosis, the primary causes of UVCP were as follows: malignant tumors (n=44), inflammation (n=16), glomus jugulare tumor (n=1) and idiopathic UVCP (n=1). The diagnostic accuracy of PET/CT imaging for the primary cause was 90.32%(56/62): 44 cases were correctly diagnosed as malignant tumors, while 11 cases as inflammation, and 1 case as glomus jugulare tumor. Among 62 patients, 29 patients had increased SUVmax in the affected side (direct invasion group; further divided into tumor group (n=12) and non-tumor group (n=17)), and other 33 patients had increased SUVmax in the healthy side (indirect invasion group). SUVmax of the affected vocal cord in direct invasion group was higher than that in the healthy side (9.97±5.21 vs 2.43±0.62; t=8.14, P<0.01). The differences between affected side and healthy side in the tumor group (14.92±3.91 vs 2.84±0.54) and the non-tumor group (6.48±2.48 vs 2.14±0.50) were statistically significant (t values: 9.94, 7.93, both P<0.01). In the indirect invasion group, SUVmax in the affected side of vocal cord was significantly lower than the healthy side (1.89±0.35 vs 6.97±2.63; t=11.44, P<0.01). There were significant differences in radioactive uptake between affected side of direct invasion group and healthy side of indirect invasion group (t=2.86, P<0.01), affected sides of tumor group and non-tumor group (t=7.46, P<0.01), affected side of tumor group and healthy side of indirect invasion group (t=6.07, P<0.01). But the radioactive uptake difference between affected side of non-tumor group and healthy side of indirect invasion group was not statistically significant (t=0.51, P>0.05).@*Conclusions@#18F-FDG PET/CT imaging has high diagnostic value in pathogenic diagnosis of non-traumatic UVCP. The different radioactive uptake of vocal cords in the affected side and the healthy side provides more accurate etiological information for clinical analysis.

Value of pathogenic diagnosis of 18F-FDG PET/CT imaging in non-traumatic unilateral vocal cord paralysis / 中华核医学与分子影像杂志

Objective To evaluate the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT imaging in non-traumatic unilateral vocal cord paralysis (UVCP) and compare the radioactive uptake in different lesions.Methods Clinical data of 62 patients (49 males,13 females;age:(61.7±12.8) years)with non-traumatic UVCP (43 cases of left vocal cord paralysis and 19 cases of right) admitted to Ji'an Hospital from January 2016 to December 2018 were analyzed retrospectively.Pathological results,imaging or follow-up results were considered as the standard of final diagnosis.The diagnostic efficacy of PET/CT imaging for the primary cause was analyzed.The maximum standardized uptake values (SUVmax) of vocal cord in patients with different etiology were compared by independent-sample t test.Results According to the final diagnosis,the primary causes of UVCP were as follows:malignant tumors (n=44),inflammation (n=16),glomus jugulare tumor (n =1) and idiopathic UVCP (n =1).The diagnostic accuracy of PET/CT imaging for the primary cause was 90.32％ (56/62):44 cases were correctly diagnosed as malignant tumors,while 11 cases as inflammation,and 1 case as glomus jugulare tumor.Among 62 patients,29 patients had increased SUVmax in the affected side (direct invasion group;further divided into tumor group (n =12) and non-tumor group (n =17)),and other 33 patients had increased SUVmax in the healthy side (indirect invasion group).SUVmax of the affected vocal cord in direct invasion group was higher than that in the healthy side (9.97±5.21 vs 2.43±0.62;t=8.14,P＜0.01).The differences between affected side and healthy side in the tumor group (14.92±3.91 vs 2.84±0.54) and the non-tumor group (6.48±2.48 vs 2.14±0.50) were statistically significant (t values:9.94,7.93,both P＜0.01).In the indirect invasion group,SUVmax in the affected side of vocal cord was significantly lower than the healthy side (1.89±0.35 vs 6.97±2.63;t =11.44,P＜0.01).There were significant differences in radioactive uptake between affected side of direct invasion group and healthy side of indirect invasion group (t =2.86,P＜0.01),affected sides of tumor group and non-tumor group (t=7.46,P＜0.01),affected side of tumor group and healthy side of indirect invasion group (t=6.07,P＜0.01).But the radioactive uptake difference between affected side of non-tumor group and healthy side of indirect invasion group was not statistically significant (t =0.51,P＞0.05).Conclusions 18F-FDG PET/CT imaging has high diagnostic value in pathogenic diagnosis of non-traumatic UVCP.The different radioactive uptake of vocal cords in the affected side and the healthy side provides more accurate etiological information for clinical analysis.

Split cricoídeo posterior endoscópico con injerto de cartílago costal / Endoscopic posterior cricoid split with costal cartilage graft

RESUMEN A pesar de los avances en cirugía de vía aérea, tanto abierta como endoscópica, la inmovilidad bilateral de cuerdas vocales continúa representando un desafio significativo para los cirujanos de vía aérea. Entre las alternativas quirúrgicas existen tanto abordajes endoscópicos como transcervicales, no obstante, la mayoría de estas técnicas modifican estructuralmente regiones de la cuerda vocal y/o aritenoides de manera permanente. La traqueostomía ha sido el tratamiento de elección en niños con inmovilidad bilateral de cuerdas vocales severamente sintomática, sin embargo, el procedimiento ideal debiese establecer una vía aérea adecuada evitando la necesidad de realizar una traqueostomía, y a la vez no generar un deterioro de la función fonatoria. La capacidad de expandir el aspecto glótico posterior sin modificación estructural de aritenoides y/o ligamento vocal ha convertido a la sección cricoidea posterior endoscópica con injerto de cartílago costal en una alternativa quirúrgica atractiva para estos casos. En este trabajo se realiza una revisión de la literatura y presenta un caso tratado mediante esta técnica en el Hospital Guillermo Grant Benavente de Concepción, Chile.

ABSTRACT Despite advances in both open and endoscopic airway surgery, bilateral vocal cord immobility still poses a significant challenge for airway surgeons. Among the surgical alternatives there are both endoscopic and transcervical approaches. However, most of these techniques structurally modify certain regions of the vocal cord and/or arytenoids permanently. Tracheostomy has been the treatment of choice in severely symptomatic children with bilateral immobility of vocal cords. Nevertheless, the ideal procedure should establish an adequate airway, avoiding the need to perform a tracheostomy, and at the same time not causing a deterioration of the phonatory function. The ability to expand the posterior glottis without structural modification of the arytenoids and/or vocal ligament has converted the posterior endoscopic cricoid split with costal cartilage graft into an attractive surgical alternative for these cases. In this article we review the literature and present a case treated by this technique in the Guillermo Grant Benavente Hospital in Concepción, Chile.

The value of acoustic parameters in the voice therapy for patients with unilateral vocal cord paralysis / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the value of acoustic parameters in the voice therapy for patients with unilateral vocal cord paralysis (UVCP).@*Methods@#From May 2015 to April 2018, 51 patients with UVCP and 59 healthy controls in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, were involved in this research retrospectively. The UVCP patients were diagnosed with stroboscopic laryngoscopy. The minimum glottal area (MGA) was calculated by KIPS software when the people were pronouncing/i:/. The fundamental frequency (F0), Jitter, Shimmer and NHR were detected by CSL4500 multiple acoustic voice analyzer.@*Results@#MGA of UVCP patients was much higher than that of healthy control (male: 433.68±64.52 vs. 294.41±51.82, t=9.23, P=0.000; female: 498.80±73.42 vs. 302.03±76.54, t=13.21, P=0.000), which meaned vocal cord insufficiency.After voice therapy, MGA reduced significantly (male: 288.48±55.09, female: 258.22±57.17, t=24.41 and 31.22, P=0.000 vs. pre-therapy). MGA of untreated patients decreased in varying degrees. Compared with the voice therapy group, the MGA decreased in a significantly lower extent (24.25±22.91 vs. 188.31±54.37, t=8.97, P=0.000). The F0, Jitter, Shimmer and NHR raised significantly in UVCP patients group (P=0.000 vs. healthy control group), and they were reduced by voice therapy (all P<0.05). Each of the four acoustic parameters was relative with MGA, r=0.551, 0.867, 0.853 and 0.875 in turn, P=0.001, 0.000, 0.000, and 0.000.@*Conclusion@#MGA and acoustic parameters can reflect the acoustic features of UVCP patients, which are useful tools in the UVCP assessment and voice therapy.

Fish Bone Migration- Culprit Leading to RetroParaoesophageal Abscess, Mediastinitis and Vocal Cord Palsy

@#Fish bone ingestion and impaction are known to everyone. However, such benign incidences have been reported to be associated with multiple potentially life threatening complications. Anatomical features of the oesophagus forms the basis for such incidences. We report here an elderly diabetic gentleman with an unusual left retro-paraoesophageal abscess complicated with oesophageal perforation, mediastinitis and vocal cord paresis which were fundamentally caused by a migrated fish bone into the lower part of the neck requiring therapeutic external neck exploration. Management of this case and its complications are described here comprehensively.

Lower Cranial Nerve Palsy Due to Vertebrobasilar Dolichoectasia

No abstract available.

The Evaluation of the Short-Term Voice Outcome of Injection Laryngoplasty Using Two Types of Calcium Hydroxylapatite (Radiesse versus Facetem) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Radiesse® is a widely used calcium hydroxyapatite (CaHA) injection material used for vocal fold injection. Recently, a new CaHA injection material (Facetem ®) which complements the structural disadvantages of Radiesse has been developed and released in the market. The aim of this study is to compare the efficacy and short-term voice outcome of these two CaHA materials. SUBJECTS AND METHOD: A retrospective analysis was performed for 70 patients with unilateral vocal fold paralysis who underwent vocal fold injection using CaHA materials. Acoustic voice analysis, maximal phonation time (MPT), voice handicap index (VHI), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale were evaluated between Radiesse and Facetem injection group. RESULTS: Both groups showed a signifcant improvement of MPT, VHI, and G, B, A scale after injection. The Facetem group showed similar voice improvement as the Radiesse group, where pre- and postoperatively objective and subjective voice evaluation results were compared. CONCLUSION: Our study reveals that there is no significant difference in efficacy and nor any short-term vocal improvement between Radiesse and Facetem. Therefore, the use of Facetem as CaHA injection material could be considered as an alternative material for patients with unilateral vocal cord paralysis.

Evaluation of Vocal Cord Paralysis after Stroke with Laryngeal Ultrasound / 中国康复理论与实践

Objective:To evaluate the vocal cord movement after stroke with laryngeal ultrasound. Methods:From January, 2017 to March, 2019, 41 patients with stroke following hoarseness were examined with laryngeal ultrasound and direct laryngoscope. The movement was graded from I to III, in which grades II and III were considered as vocal cord paresis or palsy. The results under ultrasound were compared to laryngoscope (gold standard). Results:For 82 sides vocal cords in 41 patients, 78 sides were consistent grading between laryngeal ultrasound and laryngoscopy, and the coincidence rate was 95.1%. The difference was mainly found in patients with bilateral vocal cord paralysis, two cases in total. Under ultrasound, one case was graded III (right) and I (left), and the other was graded II (right) and III (left); while under laryngoscopy, they were graded as III (right) and II (left), and III (right) and II (left), respectively. The specificity of ultrasound was 97.1%, and sensitivity was 85.7%, respectively.Kappa = 0.911, P < 0.001. Conclusion:Laryngeal ultrasound can be used for the diagnosis and evaluation of vocal cord movement after stroke.

Unilateral Vocal Cord Paralysis In Gastrointestinal Malignancies- A Rare Presentation

Background Advancements in diagnostic modalities have brought many hidden etiological causes of unilateral vocal cord paralysis (UVCP) to light. Here we are presenting two cases of gastrointestinal (GI) malignancies with metastases causing UVCP which can further add to another rare cause of UVCP. Case summary We are presenting a case of 40 year male with metastatic periampullary carcinoma leading to UVCP and another case of 45 year female with rectal carcinoma further causing UVCP. Both patients were under treatment while during follow-up, symptoms of UVCP were observed which changed our perspective towards cases of UVCP. Conclusion Vocal cord palsy is a symptom of an underlying disorder and not a disease. In above case reports metastases are the commonest etiology for vocal cord palsy. Relevant investigations have to be conducted in order to diagnose the etiology and the modality of treatment varies depending on the etiology of the condition.

Vocal cord paralysis after endotracheal intubation: an uncommon complication of general anesthesia / Paralisia de cordas vocais após intubação endotraqueal: uma complicação incomum da anestesia geral

Abstract Background: General anesthesia is a safe, frequent procedure in clinical practice. Although it is very unusual in procedures not related to head and or neck surgery, vocal cord paralysis is a serious and important complication. Incidence has been associated with patient age and comorbidities, as well as the position of the endotracheal tube and cuff. It can become a dangerous scenario because it predisposes aspiration. Objectives: To present a case and analyze the risk factors associated with increased risk of vocal cord paralysis described in the literature. Case report: 53 year-old diabetic man, who developed hoarseness in the postoperative period after receiving general anesthesia for an elective abdominal laparoscopic surgery. Otolaryngological evaluation showed left vocal cord paralysis. Conclusions: Vocal cord paralysis can be a serious complication of general anesthesia because of important voice dysfunction and risk of aspiration. The management is not yet fully established, so prevention and early diagnosis is essential.

Resumo Justificativa: A anestesia geral é um procedimento seguro e frequente na prática clínica. Embora seja muito rara em procedimentos não relacionados à cirurgia de cabeça ou pescoço, a paralisia das cordas vocais é uma complicação séria e importante. Sua incidência tem sido associada à idade e comorbidades do paciente, bem como à posição do tubo endotraqueal e seu balonete. A paralisia das cordas vocais pode ser uma condição perigosa porque predispõe à aspiração. Objetivos: Apresentar um caso e analisar os fatores de risco associados ao aumento do risco de paralisia das cordas vocais descritos na literatura. Relato de caso: Paciente do sexo masculino, 53 anos, diabético, que desenvolveu rouquidão no pós-operatório após anestesia geral para cirurgia laparoscópica abdominal eletiva. A avaliação otorrinolaringológica mostrou paralisia da corda vocal esquerda. Conclusão: A paralisia de cordas vocais pode ser uma complicação séria da anestesia geral devido ao risco grave de disfunção da voz e aspiração. O manejo dessa condição ainda não está totalmente estabelecido, de modo que a prevenção e o diagnóstico precoce são essenciais.

Técnica de Horsley para la reconstrucción del nervio laríngeo / Reconstruction of the laryngeal nerve by yhe Horsley technique

Introducción. La temida complicación de la tiroidectomía es la parálisis de las cuerdas vocales secundaria a lesiones del nervio laríngeo recurrente. En este estudio se analiza una técnica de reconstrucción para estas lesiones neurales. Objetivo. Describir los resultados funcionales de la reconstrucción inmediata de las lesiones del nervio laríngeo recurrente con la técnica de Horsley. Material y métodos. Se llevó a cabo un estudio prospectivo entre enero del 2000 y diciembre del 2015, en pacientes con sección del nervio laríngeo recurrente y reconstrucción de Horsley, en el cual se evalúan: a) los índices del análisis acústico de voz [tiempo máximo de fonación, perturbación involuntaria de la frecuencia (jitter), perturbación de la amplitud (shimmer) y frecuencia fundamental], b) los hallazgos estroboscópicos, y c) el índice de discapacidad vocal. El análisis estadístico se hizo con la prueba exacta de Fisher y con el programa SPSS™. Resultados. Se practicaron 1.547 tiroidectomías y se produjeron 10 secciones del nervio laríngeo recurrente (0,64 %): dos (0,12 %) inadvertidas (p=0,0001) y 8 (0,51 %) advertidas por infiltración tumoral. En los exámenes de la calidad de voz, se encontraron: frecuencias fundamentales bajas con medias de 104,79 ± 0,29 Hz en hombres (valor de referencia, VR=141,74) y de 208,12 ± 22,72 Hz en mujeres (VR=241,08), que se correlaciona con un jitter de 1,39 ± 0,99 % (VR=1,04); y también, disminución del tiempo máximo de fonación (media=10,9 ± 3,07 s). El índice de percepción de calidad de la voz fue de discapacidad leve de la voz (22,7 ± 11,8). La estroboscopia mostró cierre completo de la glotis en nueve pacientes (90 %) (p=0,005), con una posición adecuada de los cartílagos aritenoides, en siete. Conclusiones. La tasa de lesión inadvertida del nervio laríngeo recurrente en el Hospital Militar Central es de 0,12 %. La técnica de Horsley tiene unos resultados funcionales satisfactorios en el 90 % de los casos

Background. The most feared complication of thyroidectomy is the vocal cord palsy secondary to injury of the recurrent laryngeal nerve. In this study we analize the Horsley technique for reconstruction for this surgical injury. Objective. The aim of this study was to describe the functional outcomes of the reconstruction of the recurrent laryngeal nerve by the Horsley technique. Materials and methods. A prospective study including patients with section of the recurrent laryngeal nerve and the use of the of the Horsley technique for reconstruction was carried out in the period January 2000 to December 2015. The outcomes evaluated were: a) acoustic voice analysis indexes (maximum phonation time, involuntary disturbance of frequency (jitter), disturbance of amplitude (shimmer), and fundamental frequency); b) stroboscopic findings; and c) vocal disability index. The Fisher's exact test and the SPSS™ program were used for the statistical analysis. Results.The study included 1,547 thyroidectomies with 10 complete sections of the recurrent laringeal nerve (0.64%), 2 unnoticed injuries (0.12%) (p=0,0001), and 8 injuries identified intraoperatively in patients with tumor infiltration. In the voice quality test we found: low fundamental frequencies with median values of 104.79 ± 0, Hz in the male population (reference value, RV=141,74) and 208,12 ± 22,72 Hz in the female population (RV=241,08), wich correlates with a jitter of 1,39 ± 0,99% (RV=1,04) and with a decrease in maximum phonation time (median=10,9 ±3,07s). Index of perception of voice quality was mild voice disability (22,7 ± 11,8). Stroboscopy showed complete clossure of glottis in 9 patients (90%) (p=0,005), with an adequate position of the arytenoid cartilages in 7 patients. Conclusions. The rate of unnoticed injuries of recurrent laringeal nerve at Central Military Hospital in Bogotá, Colombia, is 0.12%. The Horsley reconstruction technique demonstrated satisfactory functional results in 90% of cases

The efficacy of ansa cervicalis anterior root for unilateral recurrent laryngeal nerve injury / 中华耳鼻咽喉头颈外科杂志

Objective@#To discuss the long-term efficacy of laryngeal reinnervation using the anterior root of the ansa cervicalis in the treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery.@*Method@#From January 2010 to January 2016, a total of 39 UVFP patients who underwent ansa cervicalis anterior root-to-recurrent laryngeal nerve (RLN) anastomosis and who had suffered nerve disfunction for 6 to 24 months were enrolled as UVFP group.Another 39 age and gender matched normal subjects served as control group. Videostroboscopy, vocal function assessment (acoustic analysis, perceptual evaluation and maximum phonation time), and laryngeal electromyography were performed preoperatively and postoperatively for assessing surgery efficacy. Paired sample t test was used for statistical analysis.@*Result@#Videostroboscopic reports indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry and regularity were significantly improved in the UVFP group (P<0.01, respectively, postoperative vs. preoperative)and showed no statistical differences compared to the control group (P>0.05, respectively). Both the postoperative GRBAS assessment and acoustic parameters were also significantly improved in the UVFP group, Pre-operative acoustic parameters/Post-operative acoustic parameters were 1.68±0.82/0.39±0.27, 10.08±2.56/4.58±2.96, 0.203±0.216/0.018±0.038, 5.96±1.92/17.42±4.11(P<0.01, respectively) and Pre-operative acoustic parameters/Post-operative acoustic parameters were 0.39±0.27/0.32±0.19, 4.58±2.96/3.32±1.27, 0.018±0.038/0.014±0.027, 17.42±4.11/18.76±5.29, which showed no statistical differences compared to the control group (P>0.05, respectively).@*Conclusion@#Delayed laryngeal reinnervation with the anterior root of ansa cervicalis, it can restore the physiological laryngeal phonatory function to the normal or a nearly normal voice quality, which is a feasible and effective approach for the treatment of thyroid surgery-related UVFP.

Effect of cricothyroid and thyroarytenoid muscle botulinum toxin injection on patients with dyspnea caused by bilateral recurrent laryngeal nerve paresis / 中华耳鼻咽喉头颈外科杂志

Objective@#To discuss the clinical effect of small dose of botulinum toxin injection in cricothyroid muscle and thyroarytenoid muscle on patients with incomplete bilateral recurrent laryngeal nerve paresis.@*Methods@#Six patients were selected with Ⅰor Ⅱ or Ⅲ degree of dyspnea diagnosed as bilateral recurrent laryngeal nerve injury by laryngeal electromyography, and small dose of botulinum toxin injection was performed in cricothyroid muscle and thyroarytenoid muscle as a treatment. Degree of dyspnea was assessed one month before and after the treatment, and the stroboscopic laryngoscope results, acoustic parameters and CT image of the patients were collected in the 6 patients. The relevant parameters were also collected one month before and after treatment, including the degree of dyspnea, stroboscopic laryngoscope results, acoustic parameters and CT image of the patients. The angle between bilateral vocal cords in stroboscopy at full inspiratory was calculated, acoustic parameters (F0, jitter, shimmer) were analysed, and vocal length, width and the vocal region were measured. Then, the paired t test was performed for statistical analysis between before and after one month injection, the one way analysis of variance was performed among vocal parameters in CT image.@*Result@#Botulinum toxin injection was successfully completed in the 6 patients, followed without any serious complications. The degree of dyspnea was alleviated to some extent after treatment in all 6 patients; the angle between bilateral vocal cords at the end of a deep inspiration was significantly increased (t=2.44, P<0.05) after the treatment. The changes of F0 and jitter between before and after treatment were not statistically significant (t=0.72, t=1.42, P>0.05). Shimmer was significantly decreased after treatment (t=2.61, P<0.05). Vocal fold length, width and vocal region increased with F0, there was a statistically significant difference between different F0 before injection, and there was no statistically significant difference between different F0 after injection. The follow-up time was respectively seven months, 1 year, 1 year, 18 months, 22 months and 2 years respectively.@*Conclusion@#Small dose of botulinum toxin injection in bilateral cricothyroid muscles and thyroarytenoid muscles can relieve the dyspnea caused by bilateral vocal cords paresis to some extent, accompanied without serious complications, despite the sound quality was slightly worse.