Airway complication after thyroid surgery: minimally invasive management of bilateral recurrent nerve injury.
OBJECTIVE
After bilateral vocal cord paralysis, the consequent paramedian position usually necessitates tracheostomy for at least 6 months, when the paralysis is potentially reversible. In the present study a reversible endoscopic vocal cord laterofixation procedure was used instead of tracheotomy.


METHODS
Prospective study of 15 consecutive patients aged 33 to 73 years who suffered bilateral recurrent laryngeal nerve paralysis after thyroid surgery.


METHODS
The operation was performed endoscopically with a special endo-extralaryngeal needle carrier instrument. Two ends of a monofilament nonresorbable thread were passed above and under the posterior third of the vocal cord and knotted on the prelaryngeal muscles, permitting the creation of an abducted vocal cord position. If movement of one or both vocal cords recovered, the suture was removed. Regular spirometric measurements and radiological aspiration tests were conducted on the patients.


RESULTS
During the follow-up period of 3 to 40 months, airway stability was demonstrated in all but one patient. After the repeated lateralization procedure, this patient's breathing improved. Partial or complete vocal cord recovery was observed in eight patients. In six patients further voice improvement was achieved when the threads were removed after vocal cord medialization or recovery. Mild postoperative aspirations ceased in the first postoperative days.


CONCLUSIONS
This management approach offers an alternative to tracheostomy in the early period of paralysis, avoids terminal loss of voice quality, and provides a "one-stage" solution for permanent bilateral recurrent nerve injuries.
Rovó
L
L
Department of Otorhinolaryngology, Head and Neck Surgery, Albert Szent-Györgyi Medical University, Szeged, Hungary. rovo@orl.szote.u-szeged.hu
Jóri
J
J
Brzózka
M
M
Czigner
J
J
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D061226:Recurrent Laryngeal Nerve Injuries; D013147:Spirometry; D013536:Suture Techniques; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*