Stridor : intracranial pathology causing postextubation vocal cord paralysis

• 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
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.87.1.39

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.