Chemo‐port insertion: A cause of vocal cord palsy

Abstract

We describe extremely rare cases of vocal cord palsy following surgical insertion of a chemo port. Our cohort consisted of patients with cancer who developed hoarseness immediately after central venous line placement for the administration of chemotherapy, with vocal cord palsy confirmed with flexible laryngoscopy. Given the timing, central venous line placement appears to be the most likely cause.

Unilateral vocal fold paralysis as a port complication

“…Alazzawi et al described four cases of reversible UVFP that occurred right after the implantation of the catheters in the internal jugular vein, which were most probably caused by a traumatic manipulation of the vagus nerve during the procedure, when dissecting the carotid sheath. 6 In the case reported by Wang et al the UVFP was caused by a rupture of the subclavian vein with drug extravasation (irinotecan) but normal mobility was recovered within 1 week of drug suspension. 7 In the case reported by Hervé et al the tip of the catheter placed in the subclavian vein migrated to the IJV and resulted in thrombosis and drug extravasation (in this case 5FU) through the vessel, which caused an UVFP that persisted for at least 4 months.…”

A report of an unexpected complication of PORT-A-CATH insertion

“…Insertion of a Port-a-cath is a surgical procedure frequently used in patients with chronic disease requiring vascular access for long-term treatment [1] , and it is used for different etiologies and indications [2] , mainly the administration of chemotherapy and parenteral nutrition [1] . It is considered a safe procedure, but care should be taken as complications can occur [4] . These complications are divided into immediate and late complications [2] , and are further divided according to their severity, the major complications of which are those that require intervention or treatment for more than a day [1] .…”

“…The recurrent laryngeal nerve is a branch of the tenth cranial nerve (Vagus Nerve) [5] , and having the surgeon familiar with the anatomy of the nerve and its path can help avoid complications [4] . Recurrent laryngeal nerve damage can be the result of direct trauma, traction, or perineural hematoma [2] , and can cause vocal cord paralysis, as it is responsible for the motility of the majority of the intrinsic muscle of the larynx [5] , and it is considered to be the second cause of vocal nerve paralysis after malignancy, approximately 24% of iatrogenic injuries [4] .…”

“…In patients whose injury resulted in unilateral vocal cord paralysis, they complain of hoarseness of the voice, sometimes associated with dysphagia and aspiration [4] . Interventions to correct the problem may be postponed because in most cases they will recover on their own [4] , and can take up to a year [2] .…”

Temporary vocal cord paralysis following hemodialysis catheter placement

“…There is only one other case discussing the possibility of local anesthetic diffusion, but that case was further complicated with breathlessness and stridor. Vocal cord palsies seen after chemo‐port insertion procedures were also noted to be because of direct nerve injuries . Local anesthesia‐related temporary vocal cord paralysis has been reported in carotid endarterectomy procedures, and the most probable mechanism was suggested to be the diffusion of local anesthetic agent .…”