Cord Paralysis Research Articles

CLINICAL FEATURES, COMPLICATIONS AND TREATMENT RESULTS OF VARICELLA ZOSTER VIRUS IN BACHMAI HOSPITAL

Objectives: Describing clinical features, complications and evaluation of treatment results caused by Varicella Zoster Virus (VZV) at Bachmai Hospital from January 1, 2018 to December 31 2019. 
 Subjects and methods: retrospective study. 67 patients Admitted at Bachmai Hospital, having realtime PCR - VZV with positive test result and VZV - IGM positive diagnostic serum test. 
 Results: Among 67 cases of VZV disease, the majority were females, accounting for 61.2%, the median age was 29 years old, 56.7% had background disease, of which 16.4% of systemic lupus erythematosus, 4.5% cancer. There are 64.2% of cases remember not being vaccinated. Only 3.0% remember having had chickenpox before. The disease caused by VZV is clinically diverse, 70.1% (47 cases) showed chickenpox disease, 25.37% (17 cases) showed water burn injury in the shingles scene and 4.5 % (3 cases) showed meningitis with no burn lesions on the skin. Uncomplicated chickenpox 29.8%, complications of chickenpox commonly encountered dermatitis and soft tissue 19.4%, complications of meningitis combined with cord paralysis 7 or common in shingles scene. As a result of treatment, 86.6% (58 cases) had no sequelae, 3.0% (2 cases) had no sequelae of consciousness disorder, and up to 10.4% (7 cases). Consolidation) serious request for return, death is recorded. 
 Conclusion: Disease caused by VZV in people with underlying systemic lupus erythematosus, cancer or pregnant women. The clinical picture is diverse, has many complications on the research group and high mortality.

Anesthetic Technique and Functional Outcomes in Modified Montgomery Thyroplasty.

Montgomery thyroplasty type I is a surgical technique indicated in vocal cord paralysis which consists of the paralyzed cord medialization, improving the voice quality. The objective of the study is to describe in detail the anesthetic method to obtain optimal post-medialization voice results. Retrospective case series study including patients who underwent medialization thyroplasty using the modified Montgomery technique at the General University Hospital of Valencia between 2011 and 2021. The anesthetic technique consisted of general anesthesia with neuromuscular relaxation and a laryngeal mask. Pre- and post-surgical vocal functional data of maximum phonation times (MPT), G score, and Voice Handicap Index-30 (VHI-30) were evaluated. All the patients presented an improvement in voice results, increasing MPT after surgery and a decrease in VHI-30 and G score postoperatively, with statistically significant differences between the pre- and post-surgical results (p-value < 0.05). There were no complications related to anesthesia or surgery. The use of general anesthesia with muscle relaxation in modified Montgomery thyroplasty may be a good option to consider. The use of a laryngeal mask for ventilation combined with a fiberoptic check allows direct visualization of the vocal cords intraoperatively, providing good functional voice results.

DESIGNING AND 3D PRINTED PLA BASED IMPLANT USED IN TREATMENT FOR UNILATERAL VOCAL CORD PARALYSIS

Vocal cord paralysis (VCP) is considered as a closure of glottal cavity during phonation. Vibration impairment in the vocal mucosa to loss of voice is as a result of the glottic space not closing. Many implant biomaterials are used for VCP. These implants, which can be applied to restore the cord function of the paralyzed cord and to improve the sound quality, are applied in Medialization thyroplasty (MT) type 1 surgeon. The aim of this study is to produce customizable poly (lactic-acid) (PLA) based vocal cord (VC), also called as vocal fold, implant by using 3D printer and compare this implant with other biomaterials. This VC 3D PLA implant (VC3DPLAI) biomaterial can be specially designed and manufactured for the individual.

Ultrasound-guided supraclavicular nerve block for implantable port catheters: Does it show a significant difference in pain control?

Nerve blocks have been used for decades at head and neck region interventions and recently introduced as an alternative option for subcutaneous port implantation. This study aimed to compare two different local anesthesia techniques used during subcutaneous port implantation. This retrospective study was conducted with 107 patients who were categorized into two groups according to the local anesthesia techniques used during port implantations. Group 1 underwent local infiltration anesthesia and Group 2 received an ultrasound-guided supraclavicular nerve block. In both groups, prilocaine 2% was used for skin anesthesia and no other systemic anesthetic drugs or additional local anesthetics were administered during port implantation. Local anesthetic doses were 400 mg in Group 1 and 200 mg in Group 2. The time required for adequate cutaneous anesthesia, procedure time, complication rate and visual analog scale (VAS) score were recorded for each patient. Groups 1 and 2 contained 58 and 49 patients respectively. Both groups showed similar demographic distributions of patients (p > 0.05). Mean procedure times and the time required for adequate cutaneous anesthesia were longer in Group 2 (p < 0.05). Group 2 also showed 12 immediate complications, although they were temporary and recovered without any intervention under surveillance. Mean VAS scores during port implantation were similar in both groups [Group 1: 1.17(±0.60), Group 2: 1.1(±0.62)] (p > 0.05). The VAS scores did not differ significantly between groups. Although a supraclavicular nerve block may require lower local anesthetic doses for similar cutaneous anesthesia, it is associated with higher immediate complication rates due to unintended blockade of the peripheral nerves. Thus, if the nerve block is preferred over local infiltration anesthesia during port implantation, to prevent life-threatening complications, caution needed especially for the patients with contralateral vocal cord or diaphragm paralysis.

Consumer Health Information for Spinal Cord Injury and Paralysis

Receiving a diagnosis of spinal cord injury can be devastating for individuals of any age and their family members. For individuals and caregivers, locating current, authoritative information and advice can be overwhelming. Access to this information can help with understanding the condition, identifying available treatments, and improving quality of life.

Hyperthermal liquid, spray, and smog may be potential risk factors for recurrent laryngeal nerve thermal injury during thyroid surgeries.

The hyperthermal liquid, spray and smog caused by energy-based surgical devices (EBDs) may be the potential risk factors for recurrent laryngeal nerve (RLN) thermal injury, but not been reported previously. We aim to demonstrated it both in thyroid surgeries and animal experiments. 321 thyroid patients and 32 rats were divided into two groups respectively. A type of endoscopic gauze was implemented in the protected group to prevent nerve from thermal risks. Electromyography and laryngoscope were recorded to determine nerve's conductive ability. Microstructural morphological damage to nerves and muscles were evaluated by light and electron microscopy in the animal experiments. After thyroid surgeries, the incidence of transient vocal cord (VC) palsy was decreased in the protected group (1.4%) compared with the conventional group (4.7%) (P = 0.037). In animal experiments, the average nerve conductive velocity was significantly decreased in the conventional group (5.8 ± 2.1 vs. 25.5 ± 4.7 m/s, P < 0.01). Typical acute morphological thermal changes of edema, coagulation and homogenization in nerve tissues were recorded by light microscopy in the conventional group. Four weeks later, the average weight of gastrocnemius muscles in the injured limb was significantly decreased (1.3 ± 0.2 vs. 2.2 ± 0.2 g, P < 0.01), while no significant difference was noted in the protected group (2.0 ± 0.3 vs. 2.3 ± 0.4 g, P = 0.61). Hyperthermal liquid, spray or smog may represent risk factors contributing to RLN thermal injury caused by EBDs. Damage to the nerve's conductive ability and morphological changes in nerves and muscles likely represent typical responses to thermal injury. Implementation of endoscopic gauze may be a promising method to protect the RLN from thermal damage especially in endoscopic thyroid surgeries.

Postintubation vocal cord palsy: possible role of pre-existing laryngeal deformity?

Background Unilateral or bilateral vocal cord (VC) paralysis following atraumatic intubation is extremely rare and has been reported even in the absence of any predisposing factors. Occurrence of such a complication is disconcerting to the clinician as well as the patient alike. Case A 42-year-old man suffering from cryptogenic cirrhosis of the liver, who underwent a deceased donor liver transplant, developed left-sided VC palsy postoperatively. No apparent cause was found and his symptoms recovered after conservative management. It was concluded that the patient possibly had recurrent laryngeal nerve neuropraxia due to compression by the endotracheal tube cuff. Conclusion We would like to briefly describe the case, possible mechanisms for VC palsy following intubation, its benign course and the possible role of pre-existing laryngeal deformity, with the aim of enhancing the awareness among anaesthesiologists about this rare complication. Although not unique to liver transplant surgeries, the relatively longer perioperative period of ventilation in such surgeries may accentuate any pressure effects.

WES homozygosity mapping in a recessive form of Charcot-Marie-Tooth neuropathy reveals intronic GDAP1 variant leading to a premature stop codon.

Charcot-Marie-Tooth disease (CMT) refers to a group of clinically and genetically heterogeneous inherited neuropathies. Ganglioside-induced differentiation-associated protein 1 GDAP1-related CMT has been reported in an autosomal dominant or recessive form in patients presenting either axonal or demyelinating neuropathy. We report two Sri Lankan sisters born to consanguineous parents and presenting with a severe axonal sensorimotor neuropathy. The early onset of the disease, the distal and proximal weakness and atrophy leading to major disability, along with areflexia, and, most notably, vocal cord and diaphragm paralysis were highly evocative of a GDAP1-related CMT. However, sequencing of the coding regions of the gene was normal. Whole-exome sequencing (WES) was performed and revealed that the largest region of homozygosity was around GDAP1 with several variants, mostly in non-coding regions. In view of the high clinical suspicion of GDAP1 gene involvement, we examined the variants in this gene and this, along with functional studies, allowed us to identify an alternative splicing site revealing a cryptic in-frame stop codon in intron 4 responsible for a severe loss of wild-type GDAP1. This work is the first to describe a deleterious mutation in GDAP1 gene outside of coding sequences or intronic junctions and emphasizes the importance of interpreting molecular analysis, and in particular WES results, in light of the clinical and electrophysiological phenotype.

Extralaryngeal variants of the location of the recurrent laryngeal nerve. Clinical observation in thyroid surgery

Возвратный гортанный нерв может иметь множество анатомических вариантов при экстраларингеальном расположении, что нередко приводит к смене техники оперативного вмешательства в каждом конкретном случае. В статье описаны два клинических наблюдения выявления невозвращающегося возвратного гортанного нерва и дополнительных коллатеральных анастомозирующих структур возвратного гортанного нерва. Невозвращающийся возвратный гортанный нерв, по данным последних исследований, встречается в общей популяции несколько чаще (до 4,8%), чем может предположить практикующий хирург-эндокринолог. Выявление невозвращающегося возвратного гортанного нерва перед операцией является важным объектом исследований. По данным многих авторов, парезы гортани при невозвращающемся возвратном гортанном нерве увеличиваются в разы по сравнению с возвращающимся гортанным нервом. Функциональное и клиническое значение анастомозирующих структур возвратного гортанного нерва до сих пор остается неизвестным. Визуализация их во время операции – редкое явление. Это приводит к их неизбежному повреждению. Таким образом, альтернативой теории тракционных повреждений возвратного гортанного нерва мы видим повреждение его нестандартных анатомических вариантов и анастомозирующих структур. В связи с редкостью выявления таких вариантов экстраларингеального расположения возвратного гортанного нерва считаем целесообразным поделиться собственным опытом.

A Study on Diagnostic Importance of Fiber Optic Laryngoscopy (FOL) in Patients with Upper Airway Disorders

Background: Upper airway symptoms are quite common. Many of these symptoms underlie serious upper airway pathologies which should be diagnosed at an early stage so that optimum treatment can be given. Often it seems to be difficult to diagnose upper air way pathology by conventional indirect laryngoscopy (I/L), especially when the lesion is at an early stage. In this situation fiber optic laryngoscopy (FOL) is very helpful.Objective: To identify lesions in the larynx in patients with persistent upper airway disorders and to compare the diagnostic yield of FOL over I/L.Method: This was a cross-sectional study conducted partly in department of ENT and Head &amp; neck surgery, BIRDEM General Hospital and partly at the same department of BSMMU during the period of July to December 2012. 100 adult patients were taken having upper airway symptoms. Study subjects were evaluated by history, physical examinations, and ENT examinations. All patients underwent indirect laryngoscopy and FOL. Data were recorded and analyzed.Results: Age of the respondents was between 18-72 years. The mean ± SD was 54 ±11.79 years. Common symptoms among the participants were hoarseness, sore throat, neck swelling, breathless ness, cough, odynophagia, earache etc. On I/L examinations 30% were vocal cord polyps, 14% v. cord edema, 17% v. cord growths, 11% v. cord nodules, 6 % v. cord palsy, 4% ulcerated lesions, 13 % poor vision and 5% were normal. On FOL examinations, 30% were vocal cord polyp, 18% v. cord edema, 21% v. cord growth, 14% v. cord nodule, 8 % v. cord palsy, 5% ulcerated lesion, 2% laryngeal web, 2 % were normal study and there were no poor vision. A comparison was made between the findings of I/L and FOL which showed that FOL is superior to I/L in diagnosing upper airway disorders as evidenced by findings of 2% lesions among 5% patients having normal I/L findings. Chi-square test was done between I/L and FOL findings which was statistically significant; (P value was .002) i.e. FOL procedure is valuable diagnostically in comparison to I/L.Conclusion: In many occasions I/L findings are inconclusive in daily ENT practice. Moreover, in some cases there is poor vision to identify the lesion. Therefore, Routine FOL evaluation is valuable in patients with significant, chronic and progressive upper airway symptoms. It should always be considered in patients with persisting and progressive symptoms even though I/L appeared normal.J Bangladesh Coll Phys Surg 2014; 32: 200-205

WITHDRAWN: Acid reflux treatment for hoarseness.

Acid reflux is a common problem, and is thought to occur in 4% to 10% of patients presenting to ENT clinics. A recent study of reflux and voice disorders suggests that up to 55% of patients with hoarseness (dysphonia) have laryngopharyngeal reflux. Anti-reflux therapy is often used empirically in treating patients with hoarseness, where no other cause has been identified by examination.The aim of the review was to assess the effectiveness of anti-reflux therapy for patients with hoarseness, in the absence of other identifiable causes, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made. This was assessed by evaluation of prospective randomised controlled studies that were identified by a systematic review of the literature. Both medical and surgical treatments were evaluated.The Cochrane ENT Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 3, 2005), MEDLINE (1966 to 2005), EMBASE (1974 to 2005) and conference proceedings were searched with prespecified terms. The date of the last search was September 2005.Randomised controlled trials recruiting patients with hoarseness in the absence of other identifiable causes, such as malignancy, cord palsy or nodules, whether or not a definitive diagnosis of laryngopharyngeal and gastro-oesophageal reflux has been made.Three reviewers examined the search results and identified studies before deciding which would be included in the review.302 potential studies were identified by the search strategy. No trials were identified which met our inclusion criteria. Six randomised controlled trials were identified in which some, but not all patients presented with hoarseness, and were treated with proton pump inhibition. As we could not determine with certainty whether all these patients had hoarseness among the other laryngeal symptoms, these were excluded. However, these studies suggest a significant placebo response, which is comparable to the benefit derived from anti-reflux therapy in some studies. As no trials met our criteria, we are unable to reach any firm conclusions regarding the effectiveness of anti-reflux treatment for hoarseness.There is a need for high quality randomised controlled trials to evaluate the effectiveness of anti-reflux therapy for patients with hoarseness which may be due to laryngopharyngeal and gastro-oesophageal reflux.

Paraplegic and quadriplegic patients undergoing emergency abdominal surgery: sicker presentations, worse outcomes.

Patients with paraplegia or quadriplegia presenting with abdominal surgical emergencies pose major clinical challenges. Difficulties in prompt diagnosis and treatment may influence patient outcomes. This is an American College of Surgeons National Surgical Quality Improvement Program study of patients undergoing an emergent abdominal operation. Patients were stratified into paraplegic (PARA), quadriplegic (QUAD), and control (CONT). PARA and QUAD groups were matched with controls by 1:2 ratio. Regression models were used to analyze the effect of paraplegia and quadriplegia on outcome. A total of 76,766 patients underwent emergent abdominal operations: 274 PARA, 132 QUAD, and 76,356 CONT patients. Lower gastrointestinal operations were the most common procedures in PARA and QUAD groups; appendectomy was the most common in the CONT group. After cohort matching, patients with cord paralysis were significantly more likely to present with severe sepsis, have "infected" wounds at operation, and have increased rates of postoperative sepsis and need for reoperation. Patients with paraplegia or quadriplegia with acute abdominal surgical emergencies are more likely to present late and have a significantly higher incidence of postoperative septic complications and longer hospital stay. Early surgical consultation and aggressive evaluation and postoperative management are warranted in these populations. Epidemiologic study, level III; therapeutic study, level IV.

Preoperative laryngoscopy in thyroid surgery: Do patients' subjective voice complaints matter?

Although routine preoperative laryngoscopy has been standard practice for many thyroid surgeons, there is recent literature that supports selective laryngoscopy. We hypothesize that patients' preoperative voice complaints do not correlate well with abnormalities seen on preoperative laryngoscopy. A retrospective chart review of a 3-year, single-surgeon experience was performed. Records of patients undergoing thyroid surgery were reviewed for patient voice complaints, prior neck surgery, surgeon-documented voice quality, and results of laryngoscopy. Of 464 patients, 6% had abnormal laryngoscopy findings, including 11 cord paralyses (2%). Preoperatively, 39% of patients had voice complaints, but only 10% had a corresponding abnormality on laryngoscopy. Only 4% of patients had a surgeon-documented voice abnormality with 72% corresponding abnormalities on laryngoscopy, including 8 cord paralyses. When eliminating patient voice complaints and using only history of prior neck surgery and surgeon-documented voice abnormality as criteria for preoperative laryngoscopy, only 1 cord paralysis is missed and sensitivity (91%) and specificity (86%) were high. Also, when compared with routine laryngoscopy, 84% fewer laryngoscopies are performed. When using patients' voice complaints as criteria for preoperative laryngoscopy, the yield is low. We recommend using surgeon-documented voice abnormalities and history of prior neck surgery as criteria for preoperative laryngoscopy.

Interarytenoid Osseous Bridge After Prolonged Endotracheal Intubation

Posterior glottic stenosis or interarytenoid fibrous adhesion is uncommon and has sometimes been misdiagnosed as cord paralysis. Laryngoscopy and laryngeal electromyography studies are the two main diagnostic aids. We present the case of a 63-year-old man under endotracheal intubation during 10 days after a cardiac procedure, who was evaluated in our department for persistent dysphonia. The laryngoscopy showed a granuloma-like lesion in the posterior glottic space. During the microlaryngoscopy procedure, the osseous consistence of the interarytenoid lesion was observed. Laser surgery excision of the lesion was performed with good results. According to our review of the literature, this corresponds to the second case reported.

Intraoperative neuromonitoring during thyroidectomy

Intraoperative neuromonitoring during thyroidectomy has become a tool available to modern thyroid surgeons. There is ongoing debate as to its effectiveness in reducing intraoperative complications, particularly vocal cord paresis and paralysis. Proponents of its use believe it increases the safety of performing thyroidectomy by improving the ability to identify and preserve the recurrent and superior laryngeal nerves. Some surgeons use it in every case, some only in selected more complicated cases and some choose not to use it at all. There are many reasons why surgeons choose to use or not use this new technology. There are no current consensus guidelines for using intraoperative neuromonitoring and the technology continues to evolve. In this article, we will outline the current scientific literature surrounding the use of neuromonitoring in thyroid surgery and will attempt to give an unbiased current assessment of this technology that is available to actively practicing thyroid surgeons.

Puente óseo interaritenoideo post-intubación laringotraqueal prolongada

Posterior glottic stenosis or interarytenoid fibrous adhesion is uncommon and has sometimes been misdiagnosed as cord paralysis. Laryngoscopy and laryngeal electromyography studies are the two main diagnostic aids. We present the case of a 63-year-old man under endotracheal intubation during 10 days after a cardiac procedure who was evaluated in our department for persistent dysphonia. The laryngoscopy showed a granuloma-like lesion in the posterior glottic space. During the microlaryngoscopy procedure, the osseous consistence of the interarytenoid lesion was observed. Laser surgery excision of the lesion was performed with good results. According to our review of the literature, this corresponds to the second case reported.

Percutaneous injection laryngoplasty in the management of acute vocal fold paralysis

To evaluate the clinical outcome of patients with acute vocal fold paralysis treated with bovine collagen via percutaneous injection laryngoplasty under simple topical anesthesia. Retrospective case series. The charts of 38 consecutive patients with acute unilateral vocal fold paralysis who underwent percutaneous injection laryngoplasty under simple topical anesthesia were reviewed. Symptoms and laryngeal function were assessed pre- and postinjection using the Glottal Function Index (GFI), GRBAS Dysphonia Scale, Functional Outcome Swallowing Scale (FOSS), and maximum phonation time (MPT). Mean GFI, GRBAS, FOSS, and MPT improved from 13.71 to 7.68, 7.24 to 3.95, 3.70 to 2.20, and 12.87 to 16.45, respectively (P < or = .0001). There were no complications related to the procedure. In seven patients requiring tube feeding secondary to dysphagia and aspiration, injection was successful in restoring oral alimentation in only three patients, with the four failures occurring in patients with multiple cranial neuropathies. Percutaneous injection laryngoplasty is a viable option for immediate rehabilitation of acute vocal fold paralysis, and can be performed in the inpatient setting. With dysphagia and aspiration secondary to multiple cranial nerve palsies, medialization of the paralyzed cord alone may be insufficient to restore safe oral alimentation.

Anomalous bronchial arteries with surgically important relationships to abnormal recurrent laryngeal nerve and thoracic duct

Department of Anatomy and Cell Biology, Osaka Medical College, Takatsuki, Osaka, JapanStudies investigating the relationships between thebronchial arteries and left recurrent laryngeal nerve(LRLN) or the thoracic duct (TD) and more impor-tantly, the clinical relevance of such relationships areseemingly very rare. Based on text books of anat-omy (Standring et al., 2008; Moore et al., 2010),there are usually two left bronchial arteries arisingfrom the thoracic aorta passing to the dorsal surfaceof left main bronchus and one right bronchial artery,which arises from the third posterior intercostalartery to the right main bronchus. However, thebronchial arteries that originate outside the areabetween the T5 and T6 vertebrae are anomalous orectopic (Yoon et al., 2002; Hartmann et al., 2007).In anatomy text books, it is always mentioned thatLRLN loops around the aortic arch during its upwardcourse toward the larynx.During the dissection of 25 cadavers, anomalouscommon bronchial artery trunk (ACBAT) arising fromthe distal aortic arch was detected in an 80-year-oldman who was suffering pneumonia shortly beforedeath (Fig. 1A and 1B). This artery was tortuous anddilated with a diameter of 2.7 mm. The LRLN loopedaround the ACBAT passing deep to it during itsupward course. The artery soon gave rise to terminalbranches which traveled along the walls of the leftmain bronchus, crossed the later ventrally towardthe carina where it terminated at the right mainbronchus. A right bronchial artery with diameter of1.1 mm originating from the third posterior intercos-tal artery and coursing toward the deep surface ofright main bronchus was observed (Fig. 1C and 1D).The TD crossed the posterior intercostal arterymedial and close to the origin of the right bronchialartery.Our report is a rare case of LRLN looping arounda tortuous dilated ACBAT with abnormal branchingpattern to the ventral aspect of the main bronchi,which is different from the literature (Hartmannet al., 2007; Standring et al., 2008). Understand-ing the clinical relevance of the variable anatomyin our case is essential for cardiothoracic surgeons,interventional radiologists and otolaryngologists. Abronchial artery with a diameter greater than 2mm is considered to be enlarged and may rupture(Chung et al., 2006; Hartmann et al., 2007).Therefore, the dilated tortuous ACBAT may ruptureresulting in severe hemoptysis (Yoon et al., 2002,Hartmann et al., 2007). Moreover, the ACBAT maybe injured during mediastinoscopy as a result of itsintimate contact with the carina (Shields et al.,2009). Ortner or cardiovocal syndrome is vocalcord paralysis due to compression of the LRLN byenlargement of heart and great vessels (Lee et al.,2006; Khaki et al., 2007). Accordingly, there is apossibility that the enlarged ACBAT may compressthe LRLN resulting in cord palsy and consequentaspiration pneumonia (Lee et al., 2006). In addi-tion, the LRLN may be damaged during emboliza-tion or ligation of ACBAT for hemoptysis treatmentor during other invasive procedures dealing withthe anomalous artery (Yoon et al., 2002; Shieldset al., 2009). In our case, the coursing of TD closeto the intercostal and right bronchial arteries maydamage it during the exposing of the intercostalartery for treatment of aortic aneurysm (Minamiet al., 2006) or during surgical procedures relatedto the right bronchial artery.

Intradural Jugular Paragangliomas: Complications and Sequelae

To present the long-term results of a group of patients who underwent surgery for intradural jugular paragangliomas. We discuss the complications, sequelae, and evolution of recurrences and behavior of residual tumors. From 1989 to 2002, 11 patients with intradural jugular paragangliomas underwent surgery using different approaches. The paragangliomas were grouped according to the classification of Fisch. Total removal of the paraganglioma was possible in eight patients, while a subtotal resection was achieved in the other three cases. The tumor remnant remained stable in two patients but continued to grow in one. Recurrence was observed in one patient. There were preoperative deficits in cranial nerves IX to XI in four patients and of XII in two patients. Deficits of cranial nerves IX to XI were acquired as a result of surgery in three cases and of XII in another. Six patients had a pure-tone average of 45 to 75 dB while the others had dead ears. Persistent dysphagia and dysphonia were managed in two patients by injection of the paralyzed cord with fat and subsequent medialization of the vocal cord by thyroplasty. Two patients had a cerebrospinal fluid leak. Surgical results in patients with extensive jugular paragangliomas are consistent and offer an acceptable quality of life even in advanced cases.

Bilateral Neuralgic Amyotrophy Presenting with Left Vocal Cord and Phrenic Nerve Paralysis

This article reports the difference between neuralgic amyotrophy and neuropathy caused by chemotherapy and radiation treatment which manifested with severe shoulder pain followed by marked weakness of bilateral upper arms and involvement of cranial nerves. A 62-year-old man presented with acute severe neuropathic pain at the left shoulder, bilateral shoulder weakness, hoarseness of voice from vocal cord palsy, and respiratory insufficiency from left diaphragm palsy, which all occurred sequentially over a 1-month period. The diagnosis of neuralgic amyotrophy was supported and differentiated from tumor-induced and radiation-induced neuropathy by clinical presentation, electrophysiologic and imaging studies. Unlike previous reports of the onset of neuralgic amyotrophy being associated with initiation of radiation treatment in cancer patients, this report demonstrates that neuralgic amyotrophy can occur at any point of the malignant disease process after radiation and chemotherapy.