Stridor : intracranial pathology causing postextubation vocal cord paralysis

During an 18-month period in a pediatric intensive care unit, nine patients with vocal cord paralysis were identified using flexible bronchoscopy. When tracheally extubated, each child was found to have stridor. The children ranged in age from 17 days to 5 1/2 years. Two patients had unilateral para...

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Bibliographic Details
Published in:Pediatrics (Evanston) 1991, Vol.87 (1), p.39-43
Main Authors: CHATEN, F. C, LUCKING, S. E, YOUNG, E. S, MICKELL, J. J
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bronchoscopy
Causes of
Child, Preschool
Complications and side effects
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Intensive care medicine
Intracranial hypertension
Intracranial Pressure - physiology
Intubation, Intratracheal - adverse effects
Ischemia - complications
Laryngeal Nerve Injuries
Medical sciences
Nerve Compression Syndromes - complications
Paralysis
Postoperative Complications
Respiratory Sounds - etiology
Retrospective Studies
Stridor
Vagus Nerve - blood supply
Vocal cord paralysis
Vocal Cord Paralysis - etiology
Vocal Cord Paralysis - physiopathology
Vocal Cord Paralysis - therapy
Vocal cords
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Summary:During an 18-month period in a pediatric intensive care unit, nine patients with vocal cord paralysis were identified using flexible bronchoscopy. When tracheally extubated, each child was found to have stridor. The children ranged in age from 17 days to 5 1/2 years. Two patients had unilateral paralysis, but neither required tracheostomy. Seven patients displayed bilateral abductor vocal cord paralysis. Of these, six patients required tracheostomy. Surgical injury to the recurrent laryngeal nerve was the probable cause in two patients. The other seven patients had neurologic disorders with documented or suspected increases of intracranial pressure. Four of the seven patients with bilateral abductor vocal cord paralysis regained cord mobility within 4 months. Both children with unilateral cord paralysis have no stridor and vocalize well 1 year later. Cord paralysis in the setting of intracranial hypertension probably results from compression or ischemia of the vagus nerve before it exits the skull. Early visualization of the larynx should be done in patients who become stridulous when extubated, especially those with prior thoracic procedures or with neurologic disorders associated with intracranial hypertension.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.87.1.39