[Prevention of bilateral vocal cord paralysis due to thyroid surgery and microsurgical management of the developed paralysis].
BACKGROUND
Following the great tradition established in the St.Rókus Hospital and Institutions by author's predecessor Prof. Aurel Réthi, there have been more than 300 patients operated on for treatment of laryngotracheal stenosis. The vast majority of the cases admitted to the department suffering from bilateral vocal cord paralysis were the consequences of thyroid surgery and its complications, which may develop even after operation by the best surgeon.


OBJECTIVE
Confronted with this challenging clinical scenario, the author became determined to focus not only on reconstruction but also on prevention.


METHODS
A new method, the neuromonitoring has been introduced first time in Hungary in the St.Rókus Hospital for thyroidectomies to simplify the identification and preservation of the recurrent nerves. As the author's department is a center for laryngotracheal reconstruction, patients from different institutions and countries were treated with larynx dilating operations, benefiting the newly developed additional techniques. With the goal of refined alternatives to previous glottis dilating operations, new methods have been worked out for the management of bilateral vocal cord paralysis based on the author's endo-extralaryngeal suture technique, mostly without tracheostomy.


RESULTS
They introduced in the last 5 years the neuromonitoring by performing thyroidectomies in 57 cases mostly for the management of malignant thyroid diseases. The recently popularized methods of the author for the management of bilateral vocal cord paralysis they were performed in the last 20 years consist of two operations, a reversible one and an irreversible one. The first operation was the reversible endo-extralaryngeal lateralization, which was carried out in 63 patients, 61 of which were successful. In the reversible technique the sutures were not removed if the cords remained paralyzed. If there was evidence of return of vocal cord function, the sutures were removed, thus eliminating the need for further dilating operations. The second operation is performed on patients whose vocal cords are paralyzed. This irreversible operation can be performed with and without arytenoidectomy. These operations were successful in 94 out of 99 patients.


CONCLUSIONS
The author feels that these two operations are quite successful because the medial mucous membrane of the vocal cord is preserved, avoiding scar and granuloma formation. The operations may be performed without any kind of tracheostomy. These are significant advantages over most other glottic dilating operations.
Lichtenberger
György
G
Fej-Nyaksebészeti Osztály. orl.rokus@mailbox.hu
D000328:Adult; D000368:Aged; D001193:Arytenoid Cartilage / Q000601:surgery; D005260:Female; D006801:Humans; D006814:Hungary; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D014833:Voice Quality