Recurrent laryngeal nerve palsy and endotracheal intubation

Tracheal ExtubationDiscussion

“…Vocal cord dysfunction can also be caused by cuff pressure from the ETT near the anterior division of the recurrent laryngeal nerve. 17 Unilateral vocal cord paralysis usually presents with uncomplicated hoarseness, which recovers within weeks. In contrast, bilateral vocal cord paralysis can cause airway obstruction, requiring immediate re-intubation.…”

Respiratory obstruction following vocal cord injection

“…Anaesthesia-related causes include trachcal i n t~b a t i o n * -~ and internal jugular vein catheterisation.s Cadaveric studies have shown that the anterior branch of the recurrent laryngeal nerve could be compressed between tracheal tube cuff and the thyroid lamina if the cuff is inflated within the larynx. 6 A paralysed cord usually lies initially in the adducted position, at a slightly lower level than the non-pardlysed cord due to altered muscular tone. With time, the cord atrophies and lies partially abducted.'…”

Bilateral Adductor Palsy: A Rare Complication during Routine Surgery

“…Paralysis of recurrent laryngeal nerve has been described as a rare complication of endotracheal intubation in cases where the patient had been free from laryngeal symptoms before the procedure, and where a cuffed intubation tube has been used although nerve was not surgically manipulated and postoperatively no signs of intubation trauma were observed. 2 The reason for vocal cord paralysis appearing in connection with anesthesia has generally been attributed to nerve compression caused by the cuff of intubation tube. 2 The anterior branch of recurrent laryngeal nerve passes medial to the lamina of the thyroid cartilage to supply the lateral cricoarytenoid and thyroarytenoid muscle.…”

“…2 The reason for vocal cord paralysis appearing in connection with anesthesia has generally been attributed to nerve compression caused by the cuff of intubation tube. 2 The anterior branch of recurrent laryngeal nerve passes medial to the lamina of the thyroid cartilage to supply the lateral cricoarytenoid and thyroarytenoid muscle. With the palsy of the anterior branch of the nerve, only the posterior cricoarytenoid, interarytenoid and cricothyroid muscles are left functioning.…”

“…It has been observed that the gases used during anesthesia can become infused into the cuff consequently increasing cuff pressure. 2 Probably, a gas pressure gradient across the semipermeable membrane of endotracheal tube cuff is the source of cuff expansion causing pressure on intralaryngeal portion of recurrent laryngeal nerve and causing neuropraxia. 4 Traditionally during neck surgeries, patient is positioned with neck hyperextended.…”