Bilateral Vocal Cord Paralysis Secondary to Head and Neck Surgery

Abstract

Even endotracheal intubation could be considered safe in operations under general anesthesia; rarely, it could cause recurrent laryngeal nerve paralysis as a complication. As mentioned in the literature, as a possible reason for this, anterior branches of the recurrent laryngeal nerve in the larynx could suffer from compression between the posteromedial part of the thyroid cartilage and the cuff of the tube. In the literature, unilateral vocal cord paralysis due to endotracheal intubation occurs more frequently in comparison to bilateral vocal cord paralysis. These types of palsies usually totally improve in approximately 6 months. A patient who experienced bilateral vocal cord paralysis in the early postoperative period after undergoing an endotracheal intubation process for general anesthesia and primary partial lip resection and supraomohyoid neck dissection due to lower lip carcinoma is presented in our article. Although vocal cord paralysis occurring after head and neck surgery is first thought as a complication of the surgery, endotracheal intubation should be considered as a possible cause of this paralysis. In relation with this patient, causes, clinical symptoms, and treatment procedures of vocal cord paralysis due to endotracheal intubation are discussed under guidance of the literature.

Bilateral vocal cord paralysis and airway obstruction during postoperative period after partial glossectomy

“…Vocal cord paralysis can also be caused by neurogenic injury to the recurrent laryngeal nerves. Neurogenic injury can be caused by surgery or less commonly, by endotracheal intubation [2,6]. Furthermore, thyroid surgery is the most common cause of recurrent laryngeal nerve injury [4,8].…”

“…Complications of endotracheal intubation include dental damage, sore throat, upper airway injury, laryngospasm, bronchospasm and vocal cord injury [1,2]. Vocal cord paralysis is a rare but serious complication of endotracheal intubation, particularly in cases of surgeries that do not involve the recurrent laryngeal nerves, with a reported incidence of 0.4-0.8% [3][4][5].…”

Transient bilateral vocal fold paralysis after total thyroidectomy

“…Indeed, although vocal fold paralysis after head and neck surgery is more likely to be considered a surgical complication, anatomic, metabolic and anesthetic factors--including endotracheal intubation should not be ignored as a possible cause of this paralysis. [14]…”

Anesthesia for Reconstructive Surgery of Head and Neck.

“…This anatomical review is relevant since, during thyroid surgery or adnexal masses or even during intubation, these nerves can be damaged, which would lead to problems in phonation or, if the nerves are damaged bilaterally, it makes breathing difficult. [12][13][14] The trachea begins at the level of the cricoid cartilage [1]. It is made up of cartilaginous rings in its anterior part and in its posterior part it is smooth, its posterior wall supposes only the smooth muscle that surrounds it as another ring.…”