title: Airway obstruction due to unilateral vocal fold paralysis.
abstract: OBJECTIVE
  Airway obstruction is an uncommon presentation of unilateral laryngeal paralysis. We have observed two mechanisms of obstruction: arytenoid prolapse and inappropriate adduction of the paralyzed vocal fold. We evaluated arytenoid abduction (AAb) and recurrent laryngeal nerve (RLN) reinnervation as treatments for airway obstruction in patients with unilateral laryngeal paralysis.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Seven patients with airway obstruction secondary to unilateral laryngeal paralysis were evaluated with flexible laryngoscopy and direct laryngoscopy. Patients with flaccid paralysis and a prolapsing arytenoid were treated with AAb. Airway obstruction due to inspiratory vocal fold adduction was managed by RLN transection and ansa reinnervation of the distal stump.
  
  
  RESULTS
  In all cases, paralysis resulted from RLN injury during surgery: thyroidectomy or cervical spine surgery. AAb was performed in four patients with arytenoid prolapse, and all had significant airway improvement, including decannulation of the two patients who had been tracheotomy dependent. RLN reinnervation was performed in five patients, two of whom had inappropriate adduction detected after AAb. The site of RLN injury was identified at surgery in all four patients. Inspiratory stridor and laryngospasm were abolished immediately after RLN transection.
  
  
  CONCLUSIONS
  Arytenoid prolapse and/or inappropriate laryngeal adduction can cause airway obstruction in patients with unilateral laryngeal paralysis. Treatment of airway obstruction should address the underlying pathophysiology. AAb and RLN transection with ansa reinnervation can be effective in selected patients.
authors.affiliation: Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9662, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Nelson
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Woodson
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology*; D001193:Arytenoid Cartilage / Q000294:innervation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D012189:Retrospective Studies; D014826:Vocal Cord Paralysis / Q000150:complications* / Q000503:physiopathology; D014827:Vocal Cords / Q000294:innervation*