Vocal Fold Motion Recovery in Patients With Iatrogenic Unilateral Immobility: Cervical Versus Thoracic Injury

Abstract

Objectives: Prognostic information about the return of vocal fold mobility in patients with iatrogenic unilateral vocal fold immobility (UVFI) can help with informed decisions about temporary and permanent treatment options. Although many variables can influence the likelihood of recovery, clinical experience suggests that cervical versus thoracic injury is a determining factor. The purpose of this study was to compare recovery rates from UVFI between cervical and thoracic injuries. Methods: A retrospective review of the medical record was performed on all adult patients diagnosed with complete iatrogenic UVFI from 2005 to 2015 (n = 923). Patients with incomplete data and etiologies of idiopathic, malignancy, or stenosis were excluded, leaving a study cohort of 502 patients who were categorized as having UVFI after cervical (n = 329) or thoracic (n = 173) injury. Data regarding site of iatrogenic injury (cervical vs thoracic), mobility status, and time interval to recovery or surgical intervention were recorded and compared using χ 2 analyses. Results: Overall, 15% of patients recovered vocal fold mobility at a median of 4.1 months. Patients with cervical injury (65 of 329 [20%]) were significantly more likely to recover mobility than patients with thoracic injury (11 of 173 [6.4%]) (odds ratio, 3.63). The cervical cohort contained more women (68% vs 31%) and was younger (mean age, 60.4 ± 13.8 vs 64.1 ± 16.1 years; Cohen's D = 0.25). Conclusions: Patients with cervical injuries resulting in UVFI are 4 times more likely to recover mobility than patients with thoracic injuries. This information can be valuable in counseling patients with UVFI and may affect clinical decision making.

Characteristics, natural evolution and surgical treatment outcomes of unilateral laryngeal paralysis versus ankylosis: A longitudinal cohort study

“…Moreover, to our best knowledge, no study directly compared the natural evolution of ULI according to its aetiology. Although literature reported much higher rates of spontaneous recovery in case of paralysis 6,18,21 than in case of ankylosis, 7,8 our results indicate that no such between‐group difference exists. Furthermore, we found that male gender and older age were both associated with lower odds of spontaneous recovery, irrespective of the aetiology.…”

Pathophysiology of iatrogenic and idiopathic vocal fold paralysis may be distinct

“…Finally, the reproducible fitting of the vocal recovery data in iatrogenic vocal fold paralysis to the previously described recovery model further supports the notion that in focal axonal injuries, it is the severity of the RLN lesion, not the distance between the lesion and the larynx, that determines the time required for reinnervation . The time‐honored assumption that the farther the injury is from the larynx, the longer the time it takes to recover, has been challenged by theoretical modeling, experimental RLN injury in animal model, and clinical data . Paniello et al showed that a difference of 5 cm in RLN lesion location did not translate into a substantial difference in time to electromyographic recovery in a canine model of RLN injury.…”

“…Paniello et al showed that a difference of 5 cm in RLN lesion location did not translate into a substantial difference in time to electromyographic recovery in a canine model of RLN injury. Tracy et al showed that the vocal fold motion recovery times between those with cervical injuries and thoracic injuries were comparable, a finding echoed by Husain et al The small difference between the median recovery times (2 weeks) in Tracy et al was much less than would have been expected based on the traditional 1 mm/day assumption for the speed of peripheral nerve regeneration, if the distance between the RLN lesion and the larynx determined the recovery time. It is more likely that longer times to recovery reflect more severe RLN injuries and the longer times it takes for repair across the injured segment.…”

Comments on “Cardiothoracic Patients with Unilateral Vocal Fold Paralysis: Pneumonia Rates Following Injection Laryngoplasty”

“…2 In addition, Tracy et al noted that patients with thoracic surgeries resulting in UVFP were less likely to recover their mobility relative to patients who had undergone cervical surgery (6.4% vs 20%). 3 Moreover, compared with permanent medialization laryngoplasty, the long-term benefit of IL remains controversial due to the absorbable properties of the injection materials. 4,5 Therefore, a sufficiently long follow-up is essential for this study to not only evaluate the pneumonia risk but also track the durability of IL.…”