Concept for diagnosis and therapy of unilateral recurrent laryngeal nerve paralysis following thoracic surgery.

Abstract

Injury to the recurrent laryngeal nerve is a potential complication in thoracic surgery, and may lead to postoperative dysfunction due to the resulting insufficient glottal closure. The aim of this study was, first, to develop an interdisciplinary concept of early diagnosis and adequate therapy of recurrent laryngeal nerve paralysis (RLNP), and second, to investigate efficiency of this approach. 120 patients (77 male, 43 female) aged between 15 and 85 years (mean 57 years) were examined otolaryngologically before and after thoracic surgery. Individual therapeutic modalities were chosen according to established criteria. In 18 patients (15 %), RLNP was found (16 left, 2 right). Five had already been diagnosed preoperatively. Functional voice therapy, stimulation-current therapy or external vocal fold medialization was performed depending on the prognostic criteria. RLNP following thoracic surgery requires immediate diagnosis and therapeutic strategy to minimize postoperative complications and to overcome impairments in the voice, swallowing, and coughing. The interdisciplinary concept presented in this study is especially advisable in high-risk RLNP procedures.