Laryngeal Electromyography Findings in Idiopathic Congenital Bilateral Vocal Cord Paralysis

1996 ◽  
Vol 105 (3) ◽  
pp. 207-212 ◽  
Author(s):  
Robert G. Berkowitz
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Prognostic Significance ◽  
Early Recovery ◽  
Bilateral Vocal Cord Paralysis ◽  
Abductor Paralysis ◽  
Significant Clinical Improvement ◽  
Posterior Cricoarytenoid ◽  
Laryngeal Emg

Children with idiopathic congenital bilateral vocal cord paralysis (BVCP) were investigated by electromyography (EMG) of the posterior cricoarytenoid and thyroarytenoid muscles to determine whether laryngeal EMG findings had diagnostic or prognostic significance. Four children between 3 weeks and 33 months of age were studied. Three had abductor paralysis and were tracheostomy-dependent, while the fourth had adductor paralysis requiring a feeding gastrostomy. Two of these patients also had other anomalies. Motor unit potentials showing phasic bursts with respiration were found in all four cases, while three children developed a full interference pattern on lightening of the anesthetic. Follow-up for between 37 and 52 months showed no significant clinical improvement in any of the patients. While the diagnosis of idiopathic congenital BVCP can represent a heterogeneous group of conditions, the findings suggest that normal laryngeal EMG findings may be a feature of idiopathic congenital BVCP but do not imply a favorable prognosis for early recovery. They may, however, have implications to explain the likely site of lesion in idiopathic congenital BVCP.

PS01.138: EXPERIENCE FROM 102 PATIENTS WITH CONTINUOUS INTRAOPERATIVE VAGUS NERVE STIMULATION DURING MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 89-89
Author(s):  
Ian Yu Hong Wong ◽  
Raymond King Yin Tsang ◽  
Desmond Kwan Kit Chan ◽  
Claudia Lai Yin Wong ◽  
Tsz Ting Law ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Vocal Cord ◽  
Nerve Stimulation ◽  
Vocal Cord Paralysis ◽  
Minimally Invasive Esophagectomy ◽  
Intraoperative Complications ◽  
Early Recovery ◽  
Invasive Esophagectomy ◽  
Assessment And Treatment

Abstract Background The incidence of recurrent laryngeal nerve (RLN) injury after esophagectomy can be as high as 60–70% especially when lymphadenectomy is performed along bilateral RLN. Vocal cord paralysis is associated with increased pulmonary complication rate, longer hospital stay, and impaired quality-of-life. The authors have modified the Continuous Intraoperative Nerve Monitoring (CIONM) method for minimally invasive esophagectomy. This study reviews our experience in the first 102 patients. Methods From May 2014 to January 2018, patients who underwent thoracoscopic esophagectomy were recruited. CIONM and intermittent nerve stimulation were routinely used during left RLN lymphadenectomy. For right RLN dissection, only intermittent nerve stimulation was used because of much lower chance of nerve injury. Routine direct laryngoscopy was performed on postoperative day one to assess the vocal cord status. Patients with RLN palsy are referred to otorhinolaryngologist for assessment and treatment. Surgical outcome, especially RLN palsy and recovery rates were documented. Results 102 patients were recruited and 73 patients had more than one year follow up. Twenty-two patients had RLN palsy (21.6%); right side in 3, left side in 18, and bilateral in one. Thirty-eight patients (37%) had only unilateral or no RLN dissection performed. This was because of R2 resection negating the benefits of RLN dissection (15.6%), poor pulmonary exposure (9.8%), other technical difficulties (7.8%), preoperative vocal cord palsy (2%), intraoperative complications (1%) and uncertain contralateral nerve integrity (1%). For those 90 patients with successful CIONM, 20 RLN palsy (22.2%), 10 of whom underwent injection thyroplasty within 2–80 days. Thyroplasty was not performed in 12 patients as they had good compensation from the contralateral cord (58.3%), early recovery within 2 weeks (16.7%) tracheostomized status (16.7%) or refusal (8.3%). Thirteen patients (59%) recovered within 2–72 weeks (Median 6 weeks). For the 73 patients with more than 1 year follow up, only 4 has residual vocal cord paralysis, making a genuine cord palsy rate of 5.5%. Conclusion Lymphadenectomy along bilateral RLN is technically demanding. CIONM is a sensitive tool to guide surgeons for safer dissection. Proper patient selection, postoperative assessment and treatment protocol can reduce the morbidity of RLN injury. Majority of the vocal cord paralysis is temporary Disclosure All authors have declared no conflicts of interest.

Laryngeal Synkinesis: Its Significance to the Laryngologist

1989 ◽  
Vol 98 (2) ◽  
pp. 87-92 ◽  
Author(s):  
Roger L. Crumley
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Basic Research ◽  
Laryngeal Electromyography ◽  
Bilateral Vocal Cord Paralysis ◽  
Laryngeal Function ◽  
Adductor Muscles ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
Intrinsic Laryngeal Muscles

Basic research and surgical cases have shown that the injured recurrent laryngeal nerve (RLN) may regenerate axons to the larynx that inappropriately innervate both vocal cord adductors and abductors. Innervation of vocal cord adductor muscles by those axons that depolarize during inspiration is particularly devastating to laryngeal function, since it produces medial vocal cord movement during inspiration. Many patients thought to have clinical bilateral vocal cord paralysis can be found to have synkinesis on at least one side. This will make the glottic airway smaller, particularly during inspiration, than would true paralysis of all the intrinsic laryngeal muscles. Patients with bilateral vocal cord paralysis should undergo laryngeal electromyography. If inspiratory innervation of the adductor muscles is present, simple reinnervation of the posterior cricoarytenoid muscle will fail. The adductor muscles also must be denervated by transection of the adductor division of the regenerated RLN.

Nerve-Muscle Pedicle Reinnervation of the Larynx: Avoiding Pitfalls and Complications

1982 ◽  
Vol 91 (4) ◽  
pp. 440-444 ◽  
Author(s):  
Harvey M. Tucker
Keyword(s):  
Vocal Cord Paralysis ◽  
Preoperative Evaluation ◽  
Neck Surgery ◽  
Patient Evaluation ◽  
Postoperative Evaluation ◽  
Bilateral Vocal Cord Paralysis ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
Nerve Muscle

The procedure for reinnervation of bilateral vocal cord paralysis using nerve-muscle pedicle technique has now been well established in the literature. Moreover, several other centers have reported success using this technique. Nevertheless, the author is aware that a significant number of well trained otolaryngology-head and neck surgery practitioners have found difficulty in making the procedure successful in their hands. It therefore seems appropriate to address those aspects of patient evaluation, technique and postoperative follow-up that have brought a satisfactory level of success in the author's hands. Preoperative evaluation of patients is the cornerstone of success in nerve-muscle pedicle reinnervation. It is imperative that the larynx be properly evaluated to be certain that there does not exist fixation or ankylosis of one or both arytenoids in addition to paralysis. Clearly if such fixation exists, nerve-muscle pedicle reinnervation cannot be successful. Several pertinent aspects of technique with special reference to the identification of the proper nerve-muscle pedicle, the design of the pedicle and proper identification of the posterior cricoarytenoid muscle will be discussed. Postoperative evaluation of patients may be difficult for inexperienced operators. The author has seen at least three patients who were operated on by other surgeons who were referred because of “failure” of the procedure only to find that all three of them were successfully reinnervated with satisfactory motion of the reinnervated cord for reasonable day-to-day activity. All aspects of postoperative evaluation and management will be discussed as well.

A rare cause of adult-onset bilateral vocal cord paralysis

2021 ◽  
Vol 14 (2) ◽  
pp. e239354
Author(s):  
Chin Mun Soong ◽  
Robin Adair
Keyword(s):  
Genetic Testing ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Motor Neuropathy ◽  
Adult Onset ◽  
Rare Occurrence ◽  
Bilateral Vocal Cord Paralysis ◽  
The World ◽  
Hereditary Motor Neuropathy

A 72-year-old man initially presented to the ENT outpatient department after 20 years with increasing intermittent episodes of dyspnoea and stridor. Flexible nasendoscopy revealed bilateral vocal cord paralysis with the cords in a medial position. He subsequently underwent urgent tracheostomy. He has six similarly affected family members across three generations all requiring tracheostomy to maintain an adequate airway. Follow-up and genetic testing have revealed mutation of the dynactin 1 gene leading to distal hereditary motor neuropathy type 7b. This is a rare occurrence causing this condition to be reported in only three families previously throughout the world.

scholarly journals A Stitch in Time

2013 ◽  
Vol 3 (1) ◽  
pp. 31-33
Author(s):  
Unnikrishnan K Menon ◽  
Janhvi J Bhate ◽  
K Madhumita
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Vocal Cord Palsy ◽  
Treatment Modalities ◽  
Bilateral Vocal Cord Paralysis ◽  
Laryngeal Lesions ◽  
The Common ◽  
The One

ABSTRACT Bilateral vocal cord paralysis is the one of the common childhood laryngeal lesions. The treatment modalities include interim tracheostomy and, where needed, permanent irreversible procedures. We report a case of idiopathic bilateral vocal cord palsy in a child, which was managed effectively by the procedure of suture lateralization of the vocal cord. The procedure, its rarity and follow-up of our case is described. How to cite this article Bhate JJ, Menon UK, Madhumita K. A Stitch in Time. Int J Phonosurg Laryngol 2013;3(1):31-33.

A Study of Vocal Cord Laterofixation during Ejnell's Technique for Bilateral Vocal Cord Paralysis.

2002 ◽  
Vol 53 (1) ◽  
pp. 1-5
Author(s):  
Etsuyo Tamura ◽  
Satoshi Kitahara ◽  
Naoyuki Kohno ◽  
Masami Ogura
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Bilateral Vocal Cord Paralysis

Recovery of Vocal Cord Motion Among Pediatric Patients

2021 ◽  
pp. 000348942110333
Author(s):  
Courtney Ann Prestwood ◽  
Ashley B. Brown ◽  
Romaine F. Johnson
Keyword(s):  
Vocal Cord ◽  
Spontaneous Recovery ◽  
Vocal Cord Paralysis ◽  
Pediatric Population ◽  
Current Evidence ◽  
Symptom Improvement ◽  
Patient Counseling ◽  
Early Recovery ◽  
Kaplan Meier ◽  
Recovery Group

Objectives: Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent interventions. This study aims to determine the time to recover spontaneously and vocal cord movement in a pediatric population and create a model for evidence-based patient counseling. Study Design: Retrospective longitudinal cohort study. Methods: The report is a single institution longitudinal study on vocal cord paralysis recovery. Patients were categorized based on spontaneous recovery with vocal cord movement or no recovery. Recovery rates were determined using the Kaplan-Meier method. Results: Of 158 cases of vocal cord paralysis over a 4-year period, 36 had spontaneous recovery with symptom improvement and motion return. The average recovery was 8.8 months for those who recovered, and 78% recovered within 9 months. Two groups emerged from the data: an early recovery group with spontaneous recovery before 12 months and a late recovery group after 12 months. Children with dysphonia and paralysis due to cardiac surgery were less likely to recover, and children with aspiration were more likely to recover. Children with gastrointestinal comorbidities were less likely to recover; however, those who did recover were more likely to have recovered after 12 months. Based on our model, there is about a 3% chance of recovery between 9 and 12 months. Conclusions: Patients should be counseled about earlier interventions. Waiting the conventional 12 months for only a 3% chance of spontaneous recovery without intervention or laryngeal EMG may not be the preferred option for some patients and their families.

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