Concept for Diagnosis and Therapy of Unilateral Recurrent Laryngeal Nerve Paralysis Following Thoracic Surgery

Schneider, B.; Schickinger-Fischer, B.; Zumtobel, Michaela; Mancusi, Gudrun; Bigenzahn, Wolfgang; Klepetko, Walter; End, Adelheid

doi:10.1055/s-2003-45426

Cited by 35 publications

(9 citation statements)

References 10 publications

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“…In addition, when a R-DLT is inserted into a patient’s airway, body heat may decrease the stiffness of the DLT. In a previous study, warming the distal part of the DLT appeared to be effective for reducing some airway complications [ 16 , 17 ] . A previous study reported that 3% of the patients were hoarse for more than 5 postoperative days [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

Wang

Gao

et al. 2018

BMC Anesthesiol

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BackgroundA right-sided double-lumen tube (R-DLT) tends to obstruct the right upper lobe intraoperatively due to anatomical distortion during surgery. If the R-DLT is poorly matched with the patient’s airway anatomy, it will not be possible to correctly replace the tube with a fiberoptic bronchoscope (FOB). In our study, we aimed to explore an efficient method for difficult repositioning caused by right upper lobe occlusion during surgery: repositioning the R-DLT from the right main bronchus into the left main bronchus. The current study was designed to assess the efficacy and safety of this method.MethodsSixty adult patients scheduled to undergo left-sided thoracic surgery were randomly assigned to two groups. With the patient in the right lateral position during surgery, the R-DLT was pulled back to the trachea while being rotated 90° clockwise; it was then either rotated 90° clockwise for placement into the left main bronchus (Group L) or rotated 90° anticlockwise and returned to the right main bronchus (Group R) using FOB guidance. The primary outcomes included clinical performance, which was measured by intubation time, and the quality of lung collapse. A secondary outcome was safety, which was determined according to bronchial injury and vocal cord injury.ResultsThe median intubation time (IQR [range]) required for placement of a R-DLT into the left main bronchus was shorter than the time required for placement into the right main bronchus (15.0 s [IQR, 12.0 to 20.0 s]) vs 23.5 s [IQR, 14.5 to 65.8 s], P = 0.005). The groups showed comparable overall results for the quality of lung collapse during the total period of one-lung ventilation (P = 1.000). The numbers of patients with bronchial injuries or vocal cord injuries were also comparable between groups (Group R, 11/30 vs. Group L 8/30, P = 0.580 for bronchus injuries; Group R, 15/30 vs. Group L 13/30, P = 0.796 for vocal cord injuries).ConclusionsRepositioning a R-DLT from the right main bronchus into the left main bronchus had good clinical performance without causing additional injury. This may be an efficient method for the difficult repositioning of a R-DLT due to right upper lobe occlusion during surgery.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-15006933, registered on 15 August 2015.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0596-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

Wang

Gao

et al. 2018

BMC Anesthesiol

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“…Although many studies have shown that the RLN nerve can partly regenerate months after surgery,1, 8 postoperative dysfunction such as dysphagia and water aspiration after RLN injury can lead to severe complications, including lung infection or even asphyxia, which may be fatal in certain patients. In patients who present with symptoms of nerve invasion, commonly regarded as a contraindication of surgery, nerve reconstruction can be considered to improve the symptoms if chemotherapy or radiotherapy has failed.…”

Section: Discussionmentioning

confidence: 99%

“…Subaortic and para‐aortic lymph nodes should be dissected for lung cancers in the left lung. Therefore, the left RLN is more frequently exposed to injury during subaortic and para‐aortic lymph node or tumor dissection because of its path around the aortic arch 1. The reported incidence of RLN injuries from esophagus and lung surgery varies greatly.…”

Section: Introductionmentioning

confidence: 99%

“…RLN injury occurs at a rate of < 2% in most reported tracheal surgery series 2. However, the rate is much higher in lung and esophagus surgeries, ranging from 4% to 31% 1. Although there have been several reports of immediate recurrent laryngeal nerve reconstruction in the thyroid or laryngeal surgical fields, this procedure is rarely conducted during thoracic surgery 3, 4, 5…”

Section: Introductionmentioning

confidence: 99%

“…Previous reports reveal a high rate of spontaneous RLN recovery six months after thoracic surgery 1. In patients with permanent RLN paralysis, consultation and intervention by an otolaryngologist is usually required.…”

Section: Introductionmentioning

confidence: 99%

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Attempt of peripheral nerve reconstruction during lung cancer surgery

Huang

et al. 2018

Thoracic Cancer

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BackgroundVagus nerve and recurrent laryngeal nerve (RLN) injury are not rare complications of lung cancer surgery and can cause lethal consequences. Until now, no optimal method other than paying greater attention during surgery has been available.MethodsFour patients underwent lung surgery that involved RLN or vagus nerve injury. The left RLN or vagus nerve was cut off and then reconstructed immediately during surgery. Two patients underwent direct anastomosis, while the remaining two underwent phrenic nerve replacing tension‐relieving anastomosis.ResultsAll patients were able to speak immediately after recovery. No or minimal glottal gap was observed during laryngoscopy conducted on the second day after surgery. Most patients achieved full recovery of voice quality.ConclusionsImmediate reconstruction of RLN is technically feasible and can be carried out with satisfying short‐term and long‐term outcomes.

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Voice Therapy for Unilateral Vocal Fold Paralysis

Stewart

Allen

2006

Vocal Fold Paralysis

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Concept for Diagnosis and Therapy of Unilateral Recurrent Laryngeal Nerve Paralysis Following Thoracic Surgery

Cited by 35 publications

References 10 publications

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

A method for addressing right upper lobe obstruction with right-sided double-lumen endobronchial tubes during surgery: a randomized controlled trial

Attempt of peripheral nerve reconstruction during lung cancer surgery

Voice Therapy for Unilateral Vocal Fold Paralysis

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