上部消化管内視鏡検査後に反回神経麻痺を来した一例

Abstract

Recurrent nerve paralysis induced by flexible fiberesophagoscopy is discussed in this article. An 82-year-old male complained of breathy hoarseness that persisted 4 weeks after an emergency flexible esophagoscopic examination. A fiberscope with on outside diameter of 9 mm was utilized and aspirin was administered for atrial fibrillation. The laryngeal fiberscopic examination revealed motility disturbance of the vocal cord on the right side and incompetent glottal closure. Abnormal mobility of the vocal fold and upper structure of the arytenoids cartilage on the affected side has been observed in cases with arytenoids cartilage dislocation. In this case, however, under videofluorographic examination of the larynx during repetitive production of phoneme/he/, such abnormal mobility was not observed. A computed tomography scan revealed a hematoma around the cricoarytenoid joint, swelling of the posterior cricoarytenoid muscle, and anterior osteophyte from the 5 to 7th cervical vertebrae which protruded mainly on the right side. In addition, an electromyographic examination of the thyroarytenoid muscle showed neurogenic pattern change. We thus concluded that his voice disorder was caused by recurrent nerve paralysis induced by flexible fiberesophagoscopy. Four weeks following these examinations, the recurrent nerve paralysis and his voice were completely recovered.