Neurogenic vocal fold motion impairment after routine intubation for tonsillectomy in a pediatric patient.
OBJECTIVE
Vocal fold motion impairment is a rare complication of general anesthesia and is more common in older patients undergoing longer duration of anesthesia. We present a case of recurrent laryngeal nerve (RLN) axonotmesis in a 16-year-old patient undergoing general anesthesia for tonsillectomy.


METHODS
Case report.


METHODS
The patient was intubated with a 6-0 oral RAE tube for routine tonsillectomy and was dysphonic postoperatively. Right vocal fold motion impairment was discovered on flexible laryngoscopy, and serial examinations with videostroboscopy were performed. She underwent laryngeal electromyography 3 months postoperatively.


RESULTS
Initial videostroboscopy demonstrated findings consistent with right RLN injury. Laryngeal electromyography showed severe active denervation of the right thyroarytenoid muscle with signs of early reinnervation, consistent with axonotmesis. Complete recovery was achieved 4 months postoperatively.


CONCLUSIONS
This case demonstrates RLN axonotmesis after brief routine intubation. The presumed mechanism of injury is compression of the nerve between the thyroid cartilage and the arytenoid or cricoid cartilage. The use of an oral RAE endotracheal tube may have contributed to the injury owing to the short distance between the bend of the tube and the cuff, placing the cuff at a higher level within the airway.
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: rkupfer@med.umich.edu.
Robbi A
RA
Kupfer
Department of Neurology, University of Michigan, Ann Arbor, Michigan.
Brian C
BC
Callaghan
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan.
Norman D
ND
Hogikyan
D000293:Adolescent; D000768:Anesthesia, General; D001696:Biomechanical Phenomena; D004576:Electromyography; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy; D010699:Phonation; D020127:Recovery of Function; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D049489:Stroboscopy; D013997:Time Factors; D014068:Tonsillectomy; D014741:Video Recording; D014827:Vocal Cords / Q000503:physiopathology*; D014832:Voice Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
Axonotmesis; Endotracheal intubation; Vocal fold motion impairment; Vocal fold paresis