Vocal Fold Immobility: A Longitudinal Analysis of Etiology Over 20 Years

Abstract

This 20-year longitudinal assessment revealed that the etiology of unilateral vocal fold immobility has changed such that there has been a shift from extralaryngeal malignancies to nonthyroid surgical procedures as the major cause. Thyroid surgery remains the most common cause of bilateral vocal fold immobility.

Complications of Airway ManagementDiscussion

“…54,55 To put these numbers into perspective, iatrogenic injury to the recurrent laryngeal nerves during surgery (such as carotid endarterectomies, anterior approaches to the cervical spine, and thyroid surgeries) accounts for the largest proportion of vocal fold immobility cases (23.9 -56%). 54 Several theories have been put forth to explain the pathogenesis of recurrent laryngeal nerve paralysis after endotracheal intubation. The recurrent laryngeal nerve runs in the trachea-esophageal groove lateral to the cricoid cartilage; its internal branch then enters the larynx between the cricoid and thyroid cartilages near the cricoarytenoid joint.…”

“…Therefore, the tube tends to rest toward the right side proximally, and toward the left side distally. 12,20,54,55 Patients may recover spontaneously when recurrent laryngeal nerve continuity has been preserved. If no motion is appreciated within 6 -12 months and/or electromyography shows signs of denervation, recovery is unlikely.…”

“…Intubation is estimated to be the cause of paralysis in 4 -7.5% of cases of unilateral vocal fold immobility and 9 -25% of cases of bilateral vocal fold immobility. 54,55 To put these numbers into perspective, iatrogenic injury to the recurrent laryngeal nerves during surgery (such as carotid endarterectomies, anterior approaches to the cervical spine, and thyroid surgeries) accounts for the largest proportion of vocal fold immobility cases (23.9 -56%). 54 Several theories have been put forth to explain the pathogenesis of recurrent laryngeal nerve paralysis after endotracheal intubation.…”

Non-Selective Laryngeal Reinnervation for Unilateral Vocal Fold Paralysis

“…Common aetiologies of UVFPare iatrogenic, neoplastic and idiopathic. However, the commonest cause is iatrogenic including thyroid surgery, carotid endarterectomy, anterior approaches to the cervical spine, and heart or great vessel surgery (1). Risk of permanent vocal fold palsy following thyroidectomy has been estimated at 1-2% (2) but this may be a considerable underestimate due to problems of followup and reporting.…”

Bilateral vocal fold immobility: diagnosis and treatment

“…Mobility of the vocal folds may be decreased or absent, and it may be unilateral or bilateral. From the standpoint of the etiology, choice of treatment, and prognosis, it is important to differentiate between hypomobility and immobility, as well as unilateral or bilateral involvement 1 . There are two forms by which patients may present bilateral vocal fold immobility: existing stridor for weeks or months that worsens rapidly to dyspnea or progressive and gradual dyspnea in the course of a few months 2 , usually with no significant changes in voice quality.…”