POSTOPERATIVE VOCAL CORD PARALYSIS IN PAEDIATRIC PATIENTS: Reports of Cases and a Review of possible Aetiological Factors

Abstract

Two cases are reported of recurrent laryngeal nerve paralysis that followed thoracic manipulations in paediatric patients. Possible aetiological factors in relation to anaesthesia and operation in paediatric and adult patients are reviewed. These include: forceful endotracheal intubation; direct surgical trauma; compression of the nerve in the neck by a tracheal cuff, or a large endotracheal tube, in the thorax by changes in the size of the great vessels; stretching of the nerve as a result of traction on distant organs; toxic effects of substances present in endotracheal tubes or formed as a result of sterilization; and the presence of a concomitant upper respiratory tract infection.

Assessment of Vocal Fold Mobility Before and After Cardiothoracic Surgery in Children

“…The left RLN descends medially and passes left of the remnant of the ductus arteriosus and then ascends medially toward the tracheoesophageal groove. 7 Possible mechanisms of VFI fol-lowing a cardiothoracic procedure include the following: compression of the RLN or its anterior branch by a cuffed endotracheal tube 8 ; mechanical laryngeal trauma resulting in dislocation and subluxation of the cricothyroid or cricoarytenoid joints 9 ; median sternotomy and excessive sternal traction resulting in the application of longitudinal strain to both RLNs via forces generated from the lateral traction of both subclavian arteries 10 ; compression of the RLN on the tracheoesophageal groove by a transesophageal echocardiographic probe 11 ; and thermal trauma from topical cardioprotective cooling or electrocautery 12 ; as well as direct surgical injury by stretching or cutting the RLN.…”

Swelling and Elongated Uvula with Unilateral Vocal Cord Paralysis after General Anesthesia

“…Vocal cord paralysis is also another rare complication of general anesthesia and most usually seen in children (1). Major symptoms of vocal cord paralysis are hoarseness and respiration difficulty.…”

“…Complications of endotracheal intubation (ETI) includes laryngeal edema, sore throat, swallowing difficulty, vocal cord paralysis, laryngeal ulcer, uvular edema or necrosis and infection, however both of uvular edema and vocal cord paralysis are very rare (1,2). Swelling and elongated uvula may cause a life-threatening airway obstruction which has to be treated quickly.…”

An Unusual Cause of Stridor Following Anaesthesia Requiring Tracheostomy

“…When stridor is associated with respiratory distress, urgent intervention is needed to relieve obstruction, which may be supraglottic, glottic, subglottic or tracheal. In the postoperative period it may be caused by mechanical or neurogenic factors [5].…”