ABSTRACT
The most common adverse event after cervical mediastinoscopy is recurrent laryngeal nerve (RLN) injury, which has an incidence of 0.6% [1]. We report the case of a 68-year-old man with non-small cell lung cancer (NSCLC) who experienced transient bilateral vocal cord paralysis after mediastinoscopy, which manifested in complete aphonia. This patient's ability to maintain his airway was carefully followed up, but neither endotracheal intubation nor tracheostomy was required. The vocal cord paralysis resolved without intervention after 5 hours. To our knowledge, this is the first reported case in which bupivicaine used at the end of a cervical mediastinoscopy diffused through the freshly dissected planes to paralyze both RLNs along the tracheoesophageal grooves.
Subject(s)
Aphonia/etiology , Mediastinoscopy/adverse effects , Vocal Cord Paralysis/etiology , Aged , Carcinoma, Non-Small-Cell Lung/diagnosis , Humans , Lung Neoplasms/diagnosis , MaleABSTRACT
To evaluate the effectiveness of sternal reconstruction using demineralized bone matrix in patients with complex sternal dehiscence. In this retrospective review, 14 patients with complex sternal wounds with dehiscence were evaluated after specific reconstructive methods. The steps involved ensuring sternal salvage by eradicating infection with a combination of vacuum assisted closure and antibiotic therapy. In a separate setting, patients underwent sternal reconstruction with plate fixation and local use of bone morphogenetic protein (BMP; Infuse, Medtronic, Minneapolis, MN) and demineralized bone matrix for remaining sternal defects. Pectoral myocutaneous flaps were then used to cover the sternum. Patients were evaluated daily in the immediate postoperative period for sternal wound complications and pain and were followed up at 3 and 6 months postoperatively. At 6 month after the procedure, all patients had stable chest walls with no further sternal instability and no recurrent dehiscences or wound infections. All patients returned to normal activity with complete resolution of sternal pain. Complex sternal wounds can be reconstructed and repaired effectively with a combination of bone salvage, local therapy with BMP, and flap closure, with encouraging results.
