Early unilateral laryngeal paralysis after pulmonary resection with mediastinal dissection for cancer.
BACKGROUND
The purpose of this study was to document the symptoms, evolution, management, and outcome in a large series of patients with an early unilateral laryngeal paralysis after mediastinal lymph node dissection and pulmonary resection for cancer.


METHODS
In this retrospective series of 69 patients, treatment relied on isolated speech therapy in 18 patients and surgical medialization of the paralyzed vocal cord in 51 patients. Duration of follow-up varied from 2 to 109 months, with a mean duration of 15 months. Treatment included isolated speech therapy and laryngeal medialization in 18 patients and 51 patients, respectively.


RESULTS
Symptoms included swallowing impairment and dysphonia noted in 63.7% and 98.5% of patients, respectively. Recovery of motion of the paralyzed larynx varied from 2.8% in patients in whom the operative report mentioned that the inferior laryngeal or Xth cranial nerve had been transected, to 23.5% in patients in whom the operative report did not mention nerve transection. Recovery of motion did not occur past the ninth month that followed thoracic surgery. When performed, medialization of the paralyzed larynx resulted in an overall 95.4% and 96% improvement rate for swallowing impairment and dysphonia, respectively, but 1 patient also died of aspiration-related pneumonia.


CONCLUSIONS
In patients with an early unilateral laryngeal paralysis after pulmonary resection with mediastinal lymph node dissection for cancer, laryngeal medialization has a beneficial impact on swallowing, speech, and voice, resulting in a better quality of life. Persistent swallowing impairment after laryngeal medialization must be managed aggressively, given the risk for delayed pneumonia and even death from aspiration.
Laccourreye
Ollivier
O
Department of Otorhinolaryngology, Head and Neck Surgery, University de Paris V-Descartes, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France. ollivier.laccourreye@egp.aphp.fr
Malinvaud
David
D
Delas
Benoit
B
Bonfils
Pierre
P
Crevier-Buchman
Lise
L
Ménard
Madeleine
M
Souilamas
Redha
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D020127:Recovery of Function; D012189:Retrospective Studies; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*