A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma

Abstract

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (Ligasure TM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient's voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case. Keywords: Vocal cord hematoma, vocal cord paralysis, hematoma, thyroidectomy INTRODUCTIONThyroid surgery is one of the most popular surgeries worldwide. Postoperative hematoma after total thyroidectomy is a major but unpredictable complication. However, it can be diagnosed by follow-up after surgery even in unsuspected cases. Although it is generally asymptomatic, patients with postoperative hematoma can suffer from a range of symptoms from ecchymosis to life-threating dyspnea (1, 2).Vocal cord paralysis (VCP) following thyroidectomy is another major complication, and its incidence has been varied (1, 2). Although VCP following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis can result from nerve damage, such as transection (complete or partial), excessive traction, direct handling, contusion, crush, thermal injury, clamping, incorrect ligature, and compromised blood supply. In addition, neurological diseases, tuberculosis, aortic aneurysms, lung and mediastinal malignancies, esophageal malignancies, metastatic tumors, and post-anesthesia complications can cause VCP (1, 2). According to a review by Jeannon et al. (3) that includes 27 articles and evaluates over 25,000 patients, the average rate of temporary VCP is 9.8% (1.4%-38.4%), whereas the average rate of permanent VCP is 2.3% (0%-18.6%). Vocal cord paralysis following thyroidectomy can result from a vocal cord hematoma with an incidence of 1.4%, due to direct injury during orotracheal intubation (incidence: 4.5%)(4, 5). In this articl...

Contralateral recurrent laryngeal nerve palsy in revision anterior cervical discectomy and fusion (ACDF): A cautionary tale

“…Traumatic surgical division of the nerve is not likely as the surgical approach did not extend to the contralateral side. Direct injury during orotracheal intubation can also lead to a vocal cord hematoma resulting in a vocal cord palsy [8]. However, this is unlikely in our patient as a formal postoperative nasoendoscopy did not reveal the presence of a vocal cord hematoma.…”