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]

• Goiter

  KEYWORDS: Cervico-mediastinal goiter; Recurrent laryngeal nerve palsy; Substernal goiter; Thyroid surgery; Total thyroidectomy [ncbi.nlm.nih.gov]

• Surgical Procedure

  Special laryngological procedures and surgical care from the beginning of paralysis are necessary for patients with vocal cord palsy. It allows to diagnose and treat patients with quite good results. [ncbi.nlm.nih.gov]

  This paper is investigating the complications directly caused by the surgical procedures. Data gained directly during surgery and 6 month after surgery allow a very detailed view on the complications. [edoc.hu-berlin.de]

  Treatment For unilateral paralysis, surgical procedures to move cords closer together For bilateral paralysis, surgical procedures and measures to maintain airway In unilateral paralysis, treatment is directed at improving voice quality through augmentation [merckmanuals.com]

• Inflammation

  Mediastinal inflammation secondary to the thrombophlebitis may be the direct cause of this unusual presentation. [ncbi.nlm.nih.gov]

  Although the cord nerves are usually working correctly, the inflammation can give vocal cord paralysis-like signs and symptoms. Some infections may also cause inflammation. [medicalnewstoday.com]

  One theory is that the common cold virus may cause nerve inflammation. [entnet.org]

  Inflammation/oedema - airway burns, anaphylaxis, physical trauma, angio-oedema, hereditary angio-oedema. [patient.info]

  Injury Injury of the RLN can occur from infection, inflammation, trauma, surgery, or malignant involvement (thyroid, parathyroid, cervical esophagus, tracheal lung, lymph nodes). [ctsnet.org]

• Lymphadenopathy

  Abstract We report a case of sarcoidosis in which the presenting features were hoarseness of voice, hilar lymphadenopathy and paralysis of the left recurrent laryngeal nerve. [ncbi.nlm.nih.gov]

  In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension. Received January 30, 1984. [onlinejacc.org]

  Despite a normal Kveim test and bronchial and transbronchial biopsy specimens, he had an unproven diagnosis of sarcoidosis based on a chest radiograph performed 17 years previously showing bilateral hilar lymphadenopathy and bilateral upper lobar nodular [thorax.bmj.com]

  • Causes: - Surgical or accidental trauma - Diptheria - Cervical lymphadenopathy - Neoplastic disease • Clinical features: - Both V.C. paralysis - Anaesthesia of larynx - Cough - Chocking fits - Weak & husky voice Treatment: - Tracheostomy with a cuffed [slideshare.net]

• Swelling

  The objectives of this study were to examine the differential palsy rates between the left and right RLNs, and the role of intraoperative nerve swelling as a risk factor of postoperative palsy. [ncbi.nlm.nih.gov]

  There was a mild soft tissue swelling anterior to the left sternocleidomastoid muscle with inspection and she had tenderness on the same region during palpation. [austinpublishinggroup.com]

  They can sustain damage anywhere along their pathway to the larynx as a result of either direct injury or from compression sustained as a result of swelling or the growth of a cyst/tumour. [britishvoiceassociation.org.uk]

• Hoarseness

  Resolution of hoarseness was approximately 70% in those with preoperative hoarseness. [ncbi.nlm.nih.gov]

• 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]

  Individuals with vocal cord paralysis may find the effectiveness of coughing, swallowing or sneezing in removing laryngeal area waste is undermined reduced vocal cord mobility. [medicalnewstoday.com]

  The glottic closure that allows a forceful cough is also compromised and thus a weak, unsuccessful cough is often reported by patients. [emedicine.medscape.com]

  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]

  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]

• 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]

  • Clinical features : - Dyspnoea - Stridor 21. [slideshare.net]

  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]

  ) 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]

• Laryngeal Disease

  Thyroid Neoplasms Vocal Cord Paralysis Endocrine System Diseases Endocrine Gland Neoplasms Neoplasms by Site Head and Neck Neoplasms Laryngeal Diseases Respiratory Tract Diseases Otorhinolaryngologic Diseases Vagus Nerve Diseases Cranial Nerve Diseases [clinicaltrials.gov]

• Voice Alteration

  Furthermore, a complete videostroboscopic examination was performed to exclude any pathological findings that may lead to voice alterations in the control group. [journals.plos.org]

• Choking

  We describe a case of a 17-year-old girl who presented with a goiter secondary to severe Graves' disease and a 2-month history of hoarseness, choking on liquid intake, and small-volume vomiting especially after eating. [ncbi.nlm.nih.gov]

  Aspiration - because there is paralysis in the area where food or liquid may go down the wrong way (aspiration), there is a risk of choking. Aspiration can lead to severe pneumonia. [medicalnewstoday.com]

  We describe a case of a 17-year-old girl who presented with a goiter secondary to severe Graves’ disease and a 2-month history of hoarseness, choking on liquid intake, and small-volume vomiting especially after eating. [pediatrics.aappublications.org]

  Patients may also complain of dysphagia or choking as glottic incompetence increases the risk of aspiration. [radiopaedia.org]

  Food and particularly liquids may 'go the wrong way' causing coughing or choking. The throat may not feel completely clear after eating or drinking so that a second swallow is necessary to clear the throat. [britishvoiceassociation.org.uk]

• Dysphagia

  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]

  Over the next two months his dysphagia resolved spontaneously. His hoarseness was improved greatly by teflon injection of the left vocal cord and speech therapy. [thorax.bmj.com]

  Often, UVFP is associated with dysphagia, specifically with liquids, because the resultant glottal incompetence can lead to aspiration. [emedicine.medscape.com]

  Patients may also complain of dysphagia or choking as glottic incompetence increases the risk of aspiration. [radiopaedia.org]

• Vomiting

  Dexamethasone use also reduced nausea and vomiting on the day of operation (P = .045). [ncbi.nlm.nih.gov]

  We describe a case of a 17-year-old girl who presented with a goiter secondary to severe Graves’ disease and a 2-month history of hoarseness, choking on liquid intake, and small-volume vomiting especially after eating. [pediatrics.aappublications.org]

  Nausea and vomiting occur mainly on the day of operation. Glucocorticoids are well known for their analgesic, anti-inflammatory, immune modulating and antiemetic effects. [clinicaltrials.gov]

• Gagging

  […] solids or liquids, the patient might choke (including saliva sometimes) While speaking, the sufferer may have to catch their breath more often than usual Voice volume may be affected - the patient may not be able to raise their voice Pharyngeal reflex (gag [medicalnewstoday.com]

  These include uvular deviation, loss of gag reflex, and atrophy of the soft palate and superior constrictor muscle. [ajnr.org]

• Suggestibility

  Recurrent laryngeal nerve palsy and thyroid disease suggest locally invasive thyroid malignancy. In contrast, recurrent laryngeal nerve palsy caused by benign multinodular goiters or ectopic thyroid tissue accounts for only 1% of cases. [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]

  Vocal forcing, however, may lead to hyperactive compensatory mechanisms that can compromise vocal outcome after vocal fold medialization. [academic.oup.com]

• Polyneuropathy

  […] syndrome associated with β 2 -microglobulin deposition in haemodialysis patients, amyloid rarely affects the peripheral nervous system and is usually of the λ type, being of monoclonal origin in 85% of cases. 6 Familial patterns of amyloid mixed peripheral polyneuropathy [thorax.bmj.com]

• Mediastinal Mass

  In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension. [ncbi.nlm.nih.gov]

  In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension. Received January 30, 1984. [onlinejacc.org]

  A right sided thoracoscopic biopsy of the mediastinal mass stained positively for amyloid with Congo Red and displayed apple-green birefringence with high intensity cross polarised light microscopy. [thorax.bmj.com]

Treatment was initiated with methimazole, with near complete remission of her vocal cord paralysis within 3 months. [ncbi.nlm.nih.gov]

Ten patients (52.6{\%}) required treatment for RLNP-6 required medical therapy (steroids), 1 interventional treatment (injection laryngoplasty), and 3 conservative therapy (speech therapy). [scholars.northwestern.edu]

[…] 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]

PMID: 9339803 Superior laryngeal nerve injury: effects, clinical findings, prognosis, and management options. Orestes MI, Chhetri DK. Orestes MI, et al. Curr Opin Otolaryngol Head Neck Surg. 2014 Dec;22(6):439-43. doi: 10.1097/MOO.0000000000000097. [pubmed.ncbi.nlm.nih.gov]

Electromyelography (EMG) can be used to determine the prognosis of RLN recovery, even if a temporary injection has occurred. [emedicine.medscape.com]

It has been shown that the cricothyroid muscle does not influence the functional prognosis or the position of the vocal fold in recurrent nerve paralysis ( 6 ). [academic.oup.com]

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 See the list below: Surgical iatrogenic injuries resulting in vocal fold paralysis include thyroid surgery, anterior cervical disc surgery, carotid surgery, or chest surgery. [emedicine.medscape.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]

After resolution of acute laryngeal findings, etiology is distinguished from two major causes of this condition. [austinpublishinggroup.com]

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]

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 [patient.info]

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]

Pathophysiology The recurrent laryngeal nerve is responsible for both abduction and adduction of the vocal fold. [emedicine.medscape.com]

Pathophysiology There are several different mechanisms of nerve injury and means of nerve regrowth ( 7 ). [academic.oup.com]

One possible pathophysiological explanation regarding this clinical presentation could be the compression of the nerve, specifically the anterior branch of RLN, 45 between an inflated endotracheal tube cuff and the overlying thyroid cartilage, especially [hormones.gr]

We aim to evaluate the role of intraoperative corticosteroids in preventing or treating postoperative RLNP. [ncbi.nlm.nih.gov]

References Apfelbaum RI, Kriskovich MD, Haller JR: On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. [anesthesiology.pubs.asahq.org]

It prevents something from entering the throat except as part of normal swallowing and helps prevent choking. Possible complications Breathing - if symptoms are severe enough the patient can have serious, life-threatening breathing problems. [medicalnewstoday.com]

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]