Challenge of Lung Isolation in Patients with Vocal Cord Implants

Abstract

: Glottic closure insufficiency increases the risk of aspiration and pneumonia, particularly in the elderly. Medialization thyroplasty is an open surgical procedure for treating glottic incompetency by approximating both vocal folds. The vocal fold medialization is achieved by inserting an implant to bring the nonmobile fold to the unaffected side. Lung isolation in patients with vocal cord implantation poses a unique challenge. Understanding the risks of different modalities of lung isolation and their impacts on the vocal cord implant is crucial to implementing a specifically tailored plan. Preoperative bronchoscopy, intraoperative video laryngoscopy, and bronchoscopy are ideal methods for assessing the vocal fold implants and guiding the lung isolation technique. Bronchial blocker through a single-lumen endotracheal tube may be the preferred choice to avoid the injury of the stretched vocal cords and dislodgement of the implant by a larger diameter double-lumen tube.

Airway management considerations in patients with vocal fold implants

“…However, the DLT poses higher risks of airway injury and the possibility of displacing the VFI (41). Therefore, isolating the lung with a bronchial blocker through a single-lumen tube would likely be a safer technique in this case (42,43). Moreover, using the non-intubation technique (bronchial blocker via the laryngeal mask airway) may be a novel solution for lung isolation, which avoids the potential injury of the VFI with the ETT in selected patients (44).…”