Observation of Vocal Fold and Pharyngeal Paralysis After Carotid Endarterectomy Using a Magnifying Laryngoscope

Background Injury to the vagus nerve or one of its branches during carotid endarterectomy (CEA) can result in vocal fold paralysis (VFP), but the exact mechanisms and site of injury responsible for VFP after CEA are unclear. The aim of this study was to identify the site of nerve injury in patients...

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Bibliographic Details
Published in:World journal of surgery 2013-04, Vol.37 (4), p.911-914
Main Authors: Tamaki, Tomonori, Node, Yoji, Saitou, Norihiro, Saigusa, Hideto
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Aged, 80 and over
Cardiac Surgery
Endarterectomy, Carotid - adverse effects
Female
General Surgery
Humans
Internal Carotid Artery
Laryngoscopes
Laryngoscopy - instrumentation
Laryngoscopy - methods
Male
Medicine
Medicine & Public Health
Middle Aged
Nerve Injury
Pharyngeal Diseases - diagnosis
Pharyngeal Diseases - etiology
Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve Injuries - diagnosis
Recurrent Laryngeal Nerve Injuries - etiology
Surgery
Thoracic Surgery
Vagus Nerve
Vagus Nerve Injuries - diagnosis
Vagus Nerve Injuries - etiology
Vascular Surgery
Vocal Cord Paralysis - diagnosis
Vocal Cord Paralysis - etiology
Vocal Fold
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Summary:Background Injury to the vagus nerve or one of its branches during carotid endarterectomy (CEA) can result in vocal fold paralysis (VFP), but the exact mechanisms and site of injury responsible for VFP after CEA are unclear. The aim of this study was to identify the site of nerve injury in patients with VFP after CEA using magnifying laryngoscopy. Methods We performed 96 consecutive CEA procedures in 87 patients over 5 years. After 56 CEA procedures, we examined vocal fold movements with a flexible nasolaryngoscope and detected VFP in 5 of 40 cases (9 %). At 6–8 weeks after CEA, these five patients also underwent magnifying laryngoscopy at another institution by a specialist in vocalization. Results We confirmed ipsilateral VFP and pharyngeal paralysis in three patients. The other two patients recovered from their nerve injuries spontaneously before the magnifying examination. Conclusions VFP and pharyngeal paralysis were caused by damage to the recurrent laryngeal and pharyngeal nerves. Therefore, the probable site of nerve injury during CEA was near the inferior vagal ganglion of the vagus nerve trunk in our three patients.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-013-1920-1