Efficiency of vocal cord medialization for recurrent laryngeal nerve dysfunction following pulmonary resections

Abstract

Background: Evaluating the incidence of postoperative vocal cord dysfunction after pulmonary resections and the impact of timing for vocal cord medialization on preventing postoperative pulmonary complications for these patients. Materials and Methods: Patients developing vocal cord dysfunction (VCD)/unilateral vocal cord paralysis (UVCP) after pulmonary resection were examined retrospectively, in terms of postoperative pulmonary complication (PPC) rates and hospital length of stay. Total of 2740 patients underwent anatomical pulmonary resection for malignancy. Eleven patients were referred to otolaryngology team with pre-diagnosis of VCD following the operation. UVCP diagnosis was confirmed with indirect laryngoscopic examination. Results: UVCP diagnosis was confirmed in 8 (0.3%) with indirect laryngoscopic examination. Performed resections were left upper lobectomy in 3 and left pneumonectomy in 5 patients. Atelectasis necessitating bronchoscopy and pneumonia were the PPC, seen in 3 (37.5%) patients. Calcium hydroxyapatite injection for 6 patients and polytetrafluoroethylene graft implantation for 2 patients was performed. Mean duration between pulmonary resection and medialization was 5.3 days in patients developing PPC and 3.6 days in patients with no PPC (p = 0.011). All patients were discharged within an average of 8.1 (6-13) days, uneventfully. One patient required re-injection of calcium hydroxyapatite on 5th month. Throughout a mean follow-up duration of 14.8 months, all patients had stable vocal cord position. Conclusions: Vocal cord medialization can be performed safely for postthoracotomy UVCP. In order to minimize phonetic and respiratory complications, this procedure must be applied on early postoperative period.