title: Vocal cord assessment with transnasal endoscopy in intubated patients after esophagectomy.
abstract: BACKGROUND
  Vocal cord paralysis (VCP) is one of the postoperative complications after radical esophagectomy. VCP may also lead to serious morbidities such as respiratory distress and aspiration pneumonia. Therefore, an early diagnosis of VCP is meaningful in the postoperative management of patients undergoing esophagectomy. We evaluated a new practical method for diagnosing postoperative VCP.
  
  
  METHODS
  The laryngeal assessment of 30 patients was performed, and the presence of VCP was inferred while the following 15 patients by endoscopy before extubation after performing consecutive radical esophagectomy in 45 esophageal cancer patients. The vocal cord mobility, including adduction and abduction, were assessed by inserting the tip of a transnasal endoscope near the vocal cord in the awake patients with orotracheal intubation on the first postoperative day. The presence of VCP was reevaluated after extubation.
  
  
  RESULTS
  Eleven of the 30 patients assessed after radical esophagectomy had unilateral VCP and one patient had bilateral VCP. The abduction findings were useful for assessing VCP and the sensitivity, specificity, positive and negative predictive values and accuracy were 97.9%, 100%, 100%, 92.9% and 98.3%, respectively. The results of the following 15 patients were closely similar.
  
  
  CONCLUSIONS
  The VCP during orotracheal intubation is assessable by transnasal endoscopy.
authors.affiliation: Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hoshino
authors.affiliation: Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenro
authors.initials: K
authors.lastname: Kawada
authors.affiliation: Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kagami
authors.initials: K
authors.lastname: Nagai
authors.affiliation: Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Department of Esophageal and General Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Kawano
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D042241:Early Diagnosis; D016145:Endoscopy, Digestive System / Q000295:instrumentation / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D012009:Recurrent Laryngeal Nerve / Q000601:surgery; D012680:Sensitivity and Specificity; D014826:Vocal Cord Paralysis / Q000175:diagnosis*; D014827:Vocal Cords / Q000503:physiopathology