Recovery of vocal fold paralysis after cardiovascular surgery.

OBJECTIVES/HYPOTHESIS: To review the incidence and time course of recovery of vocal fold paralysis (VFP) in adult patients after cardiovascular surgery. STUDY DESIGN: Retrospective cohort study of adults after cardiovascular surgery at a tertiary care academic medical center. METHODS: Patients with VFP after cardiovascular surgery were identified from a database of hospitalized patients undergoing voice and swallow evaluation. VFP was confirmed using transnasal fiberoptic laryngoscopy within 1 week of surgery. Follow-up laryngoscopy was performed in those with VFP in the outpatient clinic. Those with persistent paralysis were followed and the time course of recovery was noted. RESULTS: Eighty-six adult postoperative cardiovascular surgery patients (ages 34 to 83 years, mean 68) were identified from the inpatient voice and swallowing evaluation database. There were 20 patients (23%) with unilateral VFP. Thirteen patients followed-up for outpatient laryngoscopy. Ten of the thirteen patients (77%) ultimately had complete resolution of VFP. Three patients had persistent paralysis at a mean follow-up of 18 months. There was no obvious correlation between type of cardiovascular surgery and VFP. Signs of recovery were generally evident prior to 6 months and no recovery was seen beyond 12 months. CONCLUSIONS: Most patients with VFP after cardiovascular surgery recover fully. In accordance with previous laryngeal electromyography findings, neuropraxia during cardiovascular surgery will usually recover within 6 months.

Endoscopic removal of juvenile nasopharyngeal angiofibromas: a video presentation.

OBJECTIVES/HYPOTHESIS: Juvenile nasal angiogibroma (JNA) is a relatively rare, benign neoplasm generally seen in prepubertal and adolescent males. In the past, surgical management included lateral rhinotomy, transpalatal and transmaxillary routes, and midface degloving approaches. Endoscopic approaches have become the treatment of choice, especially for tumors limited by size and location criteria. Our presentation demonstrates an endoscopic approach to excision of JNAs that are limited to the nasal cavity, nasopharynx, and paranasal sinuses. Through the use of a brief video presentation, participants will be able to visualize the endoscopic technique. STUDY DESIGN AND METHODS: A retrospective review of JNA patients treated at our institution identified 3 patients who underwent endoscopic removal. All patients underwent preoperative embolization followed by endoscopic resection. RESULTS: A video demonstration is presented of a patient with a 3.5 cm JNA who underwent successful endoscopic, endonasal excision. After medialization of the middle turbinate and anterior ethmoidectomy, the tumor could be mobilized using a Cottle elevator and microdebrider. The origin and attachment of the tumor were visualized and detached from the sphenopalatine foramen. The tumor was resected en bloc with minimal bleeding. There were no intraoperative complications, and postoperative bleeding was negligible. To date, there has been no evidence of recurrence of tumor in these individuals. CONCLUSIONS: Endoscopic removal is the approach of choice for small to medium, limited-extent JNAs.