797 Short-Term Review of the Presentations and Outcomes of Vocal Fold Palsy Cases Identified at a Large DGH

Abstract

Abstract Aim Due to the convoluted course of the recurrent laryngeal nerves, vocal cord palsy can be a manifestation of pathologies that cross multiple surgical and medical specialties. The primary role of the vocal folds is that of airway protection. Therefore, it is important that all relevant clinicians understand this clinical scenario in order to prevent aspiration pneumonia in their patients. Method We reviewed eight months of referrals and diagnoses of patients with vocal cord paresis or palsy. This was in the setting of a tertiary Head & Neck service within a large DGH. We assessed the aetiology, management, and outcome of these cases. Results Eleven new cases were identified over the course of eight months. One was due to intrathoracic vascular pathology; one breast cancer; two from head & neck cancer; one bilateral palsy due to upper-GI cancer surgery; four from thyroid-related pathology; one lung cancer; and one idiopathic. To date, ten of eleven cases appear permanent in nature. One patient underwent in-clinic injection laryngoplasty. Two patients (18%) died within six months of diagnosis, both predictable deaths based on baseline pathology. Conclusions Our experience demonstrated the relevance of ENT (Head & Neck), Vascular, Breast, Upper-GI and Thoracic surgeons as well as medical colleagues in Endocrinology, Respiratory Medicine, and Rheumatology. We present diagnostic and management strategies to help surgical trainees across the specialties identify, manage, and refer patients to prevent complication, improve quality of life and provide access to relatively novel procedures such as awake (local anaesthetic) injection laryngoplasty.