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Recurrent Laryngeal Nerve Palsy

Laryngeal Paralysis Vagus Nerve


Presentation

  • The present study evaluates the clinicopathologic features and outcomes of patients surgically treated for well-differentiated thyroid carcinoma with documented nonfunctioning RLN at presentation.[ncbi.nlm.nih.gov]
  • We present a rare case of an intra-parenchymal thyroid epidermal cyst presenting with a left recurrent laryngeal nerve palsy. There was a complete recovery of the nerve function following surgical excision of the lesion.[ncbi.nlm.nih.gov]
  • A retrospective review was conducted of five patients presenting to the Otorhinolaryngology Head and Neck Surgery Department at Guy's and St Thomas' NHS Foundation Trust Hospital between 2000 and 2009.[ncbi.nlm.nih.gov]
  • Mediastinal inflammation secondary to the thrombophlebitis may be the direct cause of this unusual presentation.[ncbi.nlm.nih.gov]
  • Well-differentiated thyroid cancer accounts for only half of these patients who tend to present at an older age and feature a much higher incidence of upper aerodigestive tract invasion.[ncbi.nlm.nih.gov]
Euthyroid
  • For euthyroid nodular goitre, Graves' disease, chronic lymphocytic thyroiditis, recurrent goitre and thyroid carcinoma, permanent nerve damage occurred in 1.7, 4, 5, 3.8 and 8 per cent of patients respectively.[ncbi.nlm.nih.gov]
  • All thyrotoxic patients were controlled by antithyroid drugs until being euthyroid before surgery.[aamj.eg.net]
Constitutional Symptom
  • The mediastinal “amyloidoma” may represent an underlying lymphoplasmacytoma or a subtle plasma cell dyscrasia such as a Castleman's disease tumour of the solitary plasma cell variety, although this patient had no constitutional symptoms or signs of a[thorax.bmj.com]
Hoarseness
  • Resolution of hoarseness was approximately 70% in those with preoperative hoarseness.[ncbi.nlm.nih.gov]
  • Four patients' hoarseness resolved after successful interventional therapy. As for the patient with the aortic aneurysm, hoarseness persisted; the patient died before surgery.[ncbi.nlm.nih.gov]
  • Patients with RLNP typically present with hoarseness immediately after surgery owing to unilateral vocal cord paralysis.[ncbi.nlm.nih.gov]
  • BACKGROUND: Recurrent laryngeal nerve (RLN) palsy is a common complication after anterior cervical discectomy and fusion (ACDF) and usually manifests with dysphagia, hoarseness, and respiratory difficulties.[ncbi.nlm.nih.gov]
  • We report a case of an adult patient with HIV who developed hoarseness of voice due to vocal cord paralysis during vinblastine treatment for Hodgkin lymphoma.[ncbi.nlm.nih.gov]
Stridor
  • Mediastinal and hilar lymph node enlargement in such patients may distract clinicians from considering alternative causes of recurrent laryngeal nerve palsy, with potential ensuing severe or even life-threatening stridor.[ncbi.nlm.nih.gov]
  • Hypocalcaemic stridor and infantile nutritional rickets. BMJ 1995;310(6971):48-9. Srivastava A, Ravindran V. Stridor secondary to hypocalcaemia in the elderly: an unusual presentation. Eur J Intern Med 2008;19(3):219-20. Epub 2007 Sep 19.[signavitae.com]
  • Symptoms include respiratory distress with stridor. The situation often necessitates emergent reintubation or tracheostomy. Keyword history 75%/2014 64%/2011 Sources Atlee: Complications in Anesthesia, 2nd ed. 2006. Chapter 204.[openanesthesia.org]
  • . • Clinical features : - Dyspnoea - Stridor 21.[slideshare.net]
  • .- ) tobacco use ( Z72.0 ) Diseases of the respiratory system J38 ICD-10-CM Diagnosis Code J38 Diseases of vocal cords and larynx, not elsewhere classified 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 1 Excludes congenital laryngeal stridor[icd10data.com]
Cough
  • Effective closure of the glottis was then possible, permitting an adequate cough, adequate clearing of the bronchial tree and minimising the risk of aspiration.[ncbi.nlm.nih.gov]
  • Healthy function of this nerve is needed for breathing, speaking, coughing, and swallowing. The RLN goes into the chest cavity and curves back into the neck until it reaches your voice box.[entnet.org]
  • -Inability to cough: due to inability of V.C. to meet which results in retention of secretions in the chest. -Bronchopneumonia- due to repeated aspirations & retention of secretions. 27. Treatment: 1. Tracheostomy 2. Epiglottopexy 3.[slideshare.net]
  • Some specific voice disorders and their management Laryngeal nerve palsy or vocal cord paralysis This may cause a 'breathy' voice, an inefficient cough or airway narrowing.[patient.info]
  • Alternatively the voice could be hoarse with ineffective cough and choking fits. Patients with recognized palsy should be referred to speech and language therapy services.[ctsnet.org]
Gagging
  • These include uvular deviation, loss of gag reflex, and atrophy of the soft palate and superior constrictor muscle.[ajnr.org]
Distractibility
  • Mediastinal and hilar lymph node enlargement in such patients may distract clinicians from considering alternative causes of recurrent laryngeal nerve palsy, with potential ensuing severe or even life-threatening stridor.[ncbi.nlm.nih.gov]
Hyperactivity
  • Attenuation of the hyperactive immune process with methimazole may have resulted in regression of the mass effect of the thymus and associated reduction of the nerve distension.[ncbi.nlm.nih.gov]
Urinary Incontinence
  • A 75-year-old woman presented with myeloradiculopathy and chronic urinary incontinence. Imaging showed severe foraminal and central stenosis with T2 cord signal change.[ncbi.nlm.nih.gov]

Treatment

  • Treatment was initiated with methimazole, with near complete remission of her vocal cord paralysis within 3 months.[ncbi.nlm.nih.gov]
  • Generally, patients need careful ENT and surgical care including diagnosis and treatment. Four hundred and sixty-six patients who underwent thyroid operation due to cancer were analyzed.[ncbi.nlm.nih.gov]
  • Despite the adoption of a relatively conservative surgical treatment, long-term survival can be achieved in selected patients.[ncbi.nlm.nih.gov]
  • This case illustrates the benefits of thoracoscopic surgery for providing good visualization of the perineural structures and as a safe surgical treatment for a cystic mass in the aortopulmonary window.[ncbi.nlm.nih.gov]
  • We report a case of an adult patient with HIV who developed hoarseness of voice due to vocal cord paralysis during vinblastine treatment for Hodgkin lymphoma.[ncbi.nlm.nih.gov]

Prognosis

  • […] this present study is to define the significance of recurrent laryngeal nerve palsy (RLNP) detected before surgery for thyroid diseases with regard to the incidence of malignancy, histopathologic distribution, extrathyroidal invasion, management, and prognosis[ncbi.nlm.nih.gov]
  • Conclusions: Importantly, hoarseness second ary to laryngeal nerve compression in cardiovascular disease may correlate with a poorer prognosis, i.e ., in thoracic aortic aneurysms and mitral valvestenosis.[scirp.org]
  • Laryngeal electromyography and prognosis of unilateral vocal fold paralysis—a long-term prospective study. Laryngoscope 2015;125:898–903. [12]. Varaldo E, Ansaldo GL, Mascherini M, et al.[journals.lww.com]

Etiology

  • Etiology Vocal cord paralysis may result from lesions at the nucleus ambiguus, its supranuclear tracts, the main trunk of the vagus, or the recurrent laryngeal nerves.[merckmanuals.com]
  • Etiology superior thoracic masses, e.g. lung cancer (most common 7 ), aortic pathologies (e.g. thoracic aortic aneurysm ), thyroid cancer, laryngeal cancer 6,7 masses affecting the vagus nerve, e.g. jugular foramen masses, carotid body tumors surgical[radiopaedia.org]
  • Etiology and consequences. Chirurg 1998;69(9):951-6. Dionigi G, Boni L, Rovera F, Rausei S, Castelnuovo P, Dionigi R. Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury.[signavitae.com]
  • Vocal fold paresis: etiology, clinical diagnosis and clinical management. Curr Opin Otolaryngol Head Neck Surg 2014;22:444–9. [3]. Hermann M, Alk G, Roka R, et al.[journals.lww.com]

Epidemiology

  • BRLNP is rare, occurring in approx. 0.2% of thyroidectomies for benign thyroid affections. (2) Epidemiological data on late BRLNP after thyroidectomy is spares.[signavitae.com]
  • Epidemiology A retrospective analysis of data from a large American claims database found that of almost 55 million individuals, 536,943 patients (ages 0 to 65 years) were given a dysphonia diagnosis (point prevalence rate of 0.98%). [ 3 ] One study screening[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Previous literature indicates the underlying pathophysiology for delayed onset of RLNP may be small vessel ischemia, vasospasm, or viral resurgence that leads to recurrent laryngeal nerve dysfunction.[ncbi.nlm.nih.gov]

Prevention

  • We aim to evaluate the role of intraoperative corticosteroids in preventing or treating postoperative RLNP.[ncbi.nlm.nih.gov]
  • Abstract The aim of this study is to evaluate the effect of corticosteroids in preventing or treating postoperative recurrent laryngeal nerve palsy (RLNP) after total thyroidectomy.[aamj.eg.net]
  • CONCLUSION: This case highlights hypoglossal and recurrent laryngeal nerve palsy occurring without direct transection during surgery, a potentially preventable complication with careful attention to reducing compression of the lateral tongue base and[neurology.org]
  • Neoplasm of Thyroid Gland Malignant Neoplasm of Thyroid Layout table for study information Study Type : Observational Actual Enrollment : 328 participants Observational Model: Case Control Time Perspective: Prospective Official Title: Dexamethasone for the Prevention[clinicaltrials.gov]
  • Augmentation involves injecting a paste of plasticized particles, collagen, micronized dermis, or autologous fat into the paralyzed cord, bringing the cords closer together to improve the voice and prevent aspiration.[merckmanuals.com]

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