PMID- 10983944
OWN - NLM
STAT- MEDLINE
DCOM- 20001003
LR  - 20111117
IS  - 0023-852X (Print)
IS  - 0023-852X (Linking)
VI  - 110
IP  - 9
DP  - 2000 Sep
TI  - Vocal fold paralysis after anterior cervical spine surgery: incidence, mechanism, 
      and prevention of injury.
PG  - 1467-73
AB  - OBJECTIVE: Vocal fold paralysis is the most common otolaryngological complication 
      after anterior cervical spine surgery (ACSS). However, the frequency and etiology 
      of this injury are not clearly defined. This study was performed to establish the 
      incidence and mechanism of vocal fold paralysis in ACSS and to determine whether 
      controlling for endotracheal tube/laryngeal wall interactions induced by the 
      cervical retraction system could decrease the rate of paralysis. STUDY DESIGN: 
      Retrospective review and complementary cadaver dissection. METHODS: Data gathered 
      on 900 consecutive patients undergoing ACSS were reviewed for complications and 
      procedural risk factors. After the first 250 cases an intervention consisting of 
      monitoring of endotracheal tube cuff pressure and release of pressure after 
      retractor placement or repositioning was employed. This allowed the endotracheal 
      tube to re-center within the larynx. In addition, anterior approaches to the 
      cervical spine were performed on fresh, intubated cadavers and studied with 
      videofluoroscopy following retractor placement. RESULTS: Thirty cases of vocal 
      fold paralysis consistent with recurrent laryngeal nerve injury were identified 
      with three patients having permanent paralysis. With this technique temporary 
      paralysis rates decreased from 6.4% to 1.69% (P = .0002). The cadaver studies 
      confirmed that the retractor displaced the larynx against the shaft of the 
      endotracheal tube with impingement on the vulnerable intralaryngeal segment of 
      the recurrent laryngeal nerve. CONCLUSION: The study results suggest that the 
      most common cause of vocal fold paralysis after anterior cervical spine surgery 
      is compression of the recurrent laryngeal nerve within the endolarynx. 
      Endotracheal tube cuff pressure monitoring and release after retractor placement 
      may prevent injury to the recurrent laryngeal nerve during anterior cervical 
      spine surgery.
FAU - Kriskovich, M D
AU  - Kriskovich MD
AD  - Division of Otolaryngology, Head and Neck Surgery, University of Utah School of 
      Medicine, Salt Lake City 84132, USA.
FAU - Apfelbaum, R I
AU  - Apfelbaum RI
FAU - Haller, J R
AU  - Haller JR
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Cervical Vertebrae/*surgery
MH  - Female
MH  - Humans
MH  - Intraoperative Complications/prevention & control
MH  - Intubation, Intratracheal/standards
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative
MH  - *Postoperative Complications/epidemiology/etiology/prevention & control
MH  - Recurrent Laryngeal Nerve Injuries
MH  - Retrospective Studies
MH  - Surgical Procedures, Operative/*methods
MH  - *Vocal Cord Paralysis/epidemiology/etiology/prevention & control
EDAT- 2000/09/13 11:00
MHDA- 2000/10/07 11:01
CRDT- 2000/09/13 11:00
PHST- 2000/09/13 11:00 [pubmed]
PHST- 2000/10/07 11:01 [medline]
PHST- 2000/09/13 11:00 [entrez]
AID - 10.1097/00005537-200009000-00011 [doi]
PST - ppublish
SO  - Laryngoscope. 2000 Sep;110(9):1467-73. doi: 10.1097/00005537-200009000-00011.