Atrophy of the posterior cricoarytenoid muscle as an indicator of recurrent laryngeal nerve palsy.
BACKGROUND AND PURPOSE: The posterior cricoarytenoid (PCA) muscle is one of the intrinsic muscles of the larynx innervated by the recurrent laryngeal nerve. As such, recurrent laryngeal nerve palsy should not only result in paralysis of the true vocal cord or thyroarytenoid muscle but also in a similar change in the PCA muscle. The ability of CT and MR imaging to depict denervation atrophy in the PCA muscle in patients with recurrent laryngeal nerve palsy was evaluated. METHODS: Two investigators reviewed the CT and/or MR studies of 20 patients with a clinical history of vocal cord paralysis. The appearance of the PCA muscle was given a rating of 0, 1, 2, 3, or 4, with 0 being definitely normal and 4 being definitely abnormal or atrophic. Each study was also reviewed for the presence or absence of other features of vocal cord paralysis: thyroarytenoid muscle atrophy, anteromedial deviation of the arytenoid cartilage, an enlarged piriform sinus and laryngeal ventricle, and a paramedian cord. RESULTS: Atrophy of the PCA muscle was shown unequivocally in 65% of the cases and was most likely present in an additional 20%. The frequency with which other features of vocal cord paralysis were seen was as follows: thyroarytenoid atrophy, 95%; anteromedial deviation of the arytenoid cartilage, 70%; enlarged piriform sinus, 100%; enlarged laryngeal ventricle, 90%; and a paramedian cord, 100%. CONCLUSION: Atrophy of the PCA muscle may be commonly documented on CT and MR studies in patients with recurrent laryngeal nerve palsy and vocal cord paralysis, and therefore should be part of the constellation of imaging features of vocal cord paralysis. This finding is particularly useful when other imaging findings of vocal cord paralysis are absent or equivocal. (+info)
Left recurrent laryngeal nerve palsy associated with silicosis.
Left recurrent laryngeal nerve palsy usually results from invasion or compression of the nerve caused by diseases localized within the aortopulmonary window. This study reports the case of a 76-yr-old male with vocal cord paralysis due to lymph node involvement by silicosis. This rare entity was identified by video-mediastinoscopy, which revealed a granulomatous and fibrosed recurrent lymph node encasing the nerve. The nerve was dissected and released from scar tissues. Progressive clinical improvement was observed followed by total and durable recovery of the voice after 15 weeks follow-up. (+info)
Recurrent laryngeal nerve palsy associated with mediastinal amyloidosis.
Amyloidosis affecting peripheral nerves causing isolated nerve palsies is uncommon. Localised amyloidosis occurs less frequently than the reactive or immune related systemic forms, and mediastinal localisation is virtually unknown. We present a case of recurrent laryngeal nerve palsy associated with mediastinal AL amyloidosis in a middle aged man. (+info)
A series of thyroplasty cases under general anaesthesia.
Thyroplasty is an operation on the upper airway to improve voice quality in patients with unilateral vocal cord paralysis. It requires access to an uninstrumented larynx and a functional assessment of vocal cord medialization. It is a difficult anaesthetic procedure that requires sharing the airway with the surgeon. We describe an anaesthetic technique to give good operating conditions and a safe airway, using total intravenous anaesthesia, a laryngeal mask airway and intraoperative fibreoptic endoscopic assessment of the larynx, and present a series of 13 patients. Other anaesthetic techniques for thyroplasty are described and discussed. (+info)
Left vocal cord paralysis associated with long-standing patent ductus arteriosus.
SUMMARY: Left vocal cord paralysis in association with patent ductus arteriosus is unusual. We report a patient with long-standing patent ductus arteriosus (PDA) in whom CT studies obtained before and after paralysis developed showed an interval increase in size of the pulmonary trunk. The pathogenesis of left vocal cord paralysis in association with long-standing PDA is discussed. (+info)
Outcomes and complications of thyroid surgery: retrospective study.
OBJECTIVE: To study the outcome and complications of thyroid surgery. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Three hundred and twelve patients (266 women and 46 men) underwent thyroid surgery between January 1994 and December 1999. MAIN OUTCOME MEASURES: Complications of thyroidectomy for various thyroid diseases according to surgical technique used. RESULTS: Capsular dissection gradually became a more popular surgical technique: 33% and 58% in the first and second halves of the study period respectively (P<0.001). The overall rate of permanent vocal cord palsy was 2%. Near-total thyroidectomy became the preferred surgical treatment for toxic goitre over the study period. The incidence of recurrent hyperthyroidism was reduced from 21% to 7% (P>0.1, not significant). The incidence of hypoparathyroidism was approximately 30% after thyroidectomy for cancer. CONCLUSION: Capsular dissection is increasingly utilised in thyroid surgery. Low complication rates can be achieved after thyroidectomy for benign diseases. Hypoparathyroidism, however, is a relatively common complication after surgery for thyroid cancer. (+info)
Cordotomy for bilateral cord abductal paralysis.
OBJECTIVE: To investigate the clinical effects of cordotomy on bilateral cord abductal paralysis. METHODS: With unilateral cordotomy, we treated 4 patients with bilateral cord paralysis whose glottis size was about 2.0 mm to 2.5 mm. They were followed up for over one year. RESULTS: One week after surgery, the tracheotomy tubes of all 4 patients were plugged and no dyspnea occurred during rest and mild action. Their voices were more hoarse than before surgery. After 3 months, the tracheotomy tubes were successfully decannulated, and in the following one year, their respiration was normal and then speech was clear, although their voices were still a little hoarse. CONCLUSION: We suggest that cordotomy be one option in the treatment of bilateral cord abductal paralysis. (+info)
Use of the laryngeal mask airway in thyroid and parathyroid surgery as an aid to the identification and preservation of the recurrent laryngeal nerves.
A prospective study was carried out in patients undergoing thyroid and parathyroid surgery using a laryngeal mask airway (LMA) and electrical nerve stimulation to identify the recurrent laryngeal nerves. A total of 150 consecutive patients undergoing thyroid and parathyroid surgery by a single surgeon were assessed for suitability of anaesthesia via the LMA. Peroperatively, a fibre-optic laryngoscope was passed through the LMA to enable the anaesthetist to visualise the vocal cords while adduction of the cords was elicited by applying a nerve stimulator in the operative field. In all, 144 patients were selected for anaesthesia via the LMA. Fibre-optic laryngoscopy and nerve stimulation were performed in 64 patients (42.7%). The trachea was deviated in 51 (34.0%) and narrowed in 33 (22.0%). The recurrent laryngeal nerves were identified in all patients. There were no cases of vocal cord dysfunction resulting from surgery. The LMA can be safely used for thyroid and parathyroid surgery even in the presence of a deviated or narrowed trachea. It can assist in identification and preservation of the recurrent laryngeal nerve and is, therefore, of benefit to both patient and surgeon. (+info)