Recurrent Laryngeal Nerve Involvement Research Articles

Comparison of pembrolizumab plus chemotherapy versus concurrent or sequential radiochemotherapy in patients with driver mutation-lacking lung adenocarcinoma presenting with recurrent laryngeal nerve invasion leading to hoarseness.

e14635 Background: For patients with advanced non-small cell lung cancer (NSCLC), particularly those with adenocarcinoma lacking a driver mutation, the encroachment upon the recurrent laryngeal nerve causing hoarseness presents a substantial challenge in treatment. Such patients, at TNM stage IIIB or higher, may undergo platinum-based doublet chemotherapy combined with concurrent or sequential radiotherapy. Despite these treatments, survival rates remain modest, and quality of life is significantly impaired by symptoms such as hoarseness, dysphagia, and coughing. Recently, pembrolizumab combined with chemotherapy has emerged as a frontline treatment for adenocarcinoma patients, showing promising outcomes in unresectable, advanced stages of the disease. However, its efficacy in patients experiencing hoarseness due to recurrent laryngeal nerve involvement has not been previously investigated. Methods: Between September 2018 and October 2022, Jiangmen Central Hospital admitted 71 patients with advanced adenocarcinoma and hoarseness, who lacked a driver mutation as confirmed by NGS testing. After excluding patients who did not complete the treatment plan, the remaining subjects were randomly divided into two groups. The treatment group, consisting of 21 patients, received pembrolizumab, pemetrexed, and platinum-based doublet chemotherapy. The control group, also comprising 21 patients, underwent concurrent or sequential radiotherapy alongside pemetrexed and platinum-based chemotherapy. Results: Among the treatment group, hoarseness was reversed in 13 out of 21 patients, with a return to normal vocal function. In the control group, 5 out of 21 patients experienced a reversal of hoarseness. The treatment group showed superior outcomes in reversing hoarseness caused by recurrent laryngeal nerve involvement (p=0.013). The objective response rate (ORR) in the treatment group was 28.57%, with a disease control rate (DCR) of 66.67%. In contrast, the control group had an ORR of 9.52% and a DCR of 28.57% (p<0.05). The Progression-Free Survival (PFS), as calculated by the Kaplan-Meier survival curve method, was 11.77 months (95% CI: 11.19-12.35) in the treatment group and 7.53 months (95% CI: 6.73-8.33) in the control group, indicating a significantly higher survival rate in the treatment group (p<0.05). Conclusions: In patients with advanced lung adenocarcinoma, pembrolizumab combined with chemotherapy appears to effectively reverse hoarseness caused by recurrent laryngeal nerve involvement, higher objective response rates, and increased PFS. This suggests the necessity for multicentric, prospective, evidence-based studies in the treatment of lung adenocarcinoma patients with hoarseness due to recurrent laryngeal nerve invasion.

Impact of thyroid carcinoma invasion of recurrent laryngeal nerve on cervical lymph node metastasis.

Papillary thyroid carcinoma (PTC) has a favorable prognosis. However, involvement of the recurrent laryngeal nerve (RLN) significantly increases the risk of recurrence. RLN invasion was an important factor in determining the extent of thyroid surgery. The purpose of this study was to compare clinicopathologic features and characterize risk factors of central and lateral lymph node metastasis (LLNM) of RLN invasion in patients with PTC. A retrospective review was conducted of 130 patients with PTCs who had exclusive tumor involvement of the RLN at our institution between January 2014 and February 2019. All patients underwent total thyroidectomy and high-dose radioactive iodine (RAI) therapy. The clinicopathologic factors and prognostic outcomes of the patients with solitary and multiple RLN involvements were compared. Kaplan-Meier method was performed to compare the outcomes of tumor recurrence. Univariate and multivariate logistic regression analyses were used to identify risk factors associated with LLNM. The invasion of the RLN was similar on both sides, with 58.5% on the right, 40.0% on the left, and 1.5% on both sides. Significant differences were observed in tumor size (p < 0.001), lymph node metastasis classification (p = 0.002), RLN resection (p < 0.001), and thyroglobulin (p = 0.010) in the solitary and multiple groups. During the median follow-up of 67 months, 9 (6.9%) patients developed recurrence. There were no statistical differences in recurrence for age, tumor size, gender, multifocality, lymph node metastasis (LNM), and RLN resection. According to receiver operating characteristic (ROC) curve analyses, a cut-off of tumor size > 1.7 cm was identified as the most sensitive and specific predictor of RLN with multiple involvements or LNM invasion. Univariate and multivariate analyses revealed that central lymph node metastasis (CLNM) and RLN invasion by LNM can serve as independent risk factors for LLNM (p = 0.006 and p < 0.001, respectively). Our results indicate that recurrence was comparable in patients with solitary and multiple RLN involvements. Multiple RLN involvement was associated with pathological features such as larger tumors, RLN resection, and LLNM. The presence of LNM invading RLN and multiple nerve involvement increases the risk of intraoperative RLN resection. A higher risk of multiple invasion or LNM invasion should be considered when tumor size > 1.7 cm. The presence of CLNM and RLN invaded by LNM were independent predictors for LLNM, which could aid surgeons in deciding on lateral lymph node dissection.

A vocal cord palsy caused by the uterine cancer metastatic tumor in the mediastinum revealed in a patient with a thyroid lesion: a case report and review of the literature

BackgroundThe main cause of vocal cord palsy (VCP) is idiopathic impairment of the recurrent laryngeal nerve (RLN). However, solid tumors along the pathway of the RLN can also impact the nerve’s function. We presented a patient with a thyroid lesion and VCP due to a bulky metastatic mass (uterine cancer) on the aortic arch field in the mediastinum. The report aims to show the significance of comorbid tumors in thyroid pathology and the importance of additional diagnostic methods in avoiding unnecessary surgeries. A patient’s lifetime and the outcome of the disease were also presented.Case presentationA 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.ConclusionA history of the disease should always be kept in mind when assessing a patient’s complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.

Hoarseness of Voice Due to Ipsilateral Recurrent Laryngeal Nerve Palsy in Ultrasound Guided Right Sided Supraclavicular Brachial Plexus Block: A Case Report

Supraclavicular brachial plexus block is well established regional anaesthesia technique for upper limb surgeries. USG guided supraclavicular brachial plexus block provides many advantages but is also associated with the rare complication of recurrent laryngeal nerve palsy, seen in 1.3% of cases. Recurrent laryngeal nerve palsy is mostly documented in right sided supraclavicular blocks than left sided supraclavicular blocks. Here, we report a case of 28 years old male undergoing right upper arm surgery under supraclavicular block who developed hoarseness of voice due to ipsilateral recurrent laryngeal nerve involvement which was followed up properly and managed successfully.

Clinical characteristics and prognosis of anaplastic thyroid carcinoma: a 20-year single-center retrospective study

Objectives: To investigate the clinical characteristics and prognoses of patients with anaplastic thyroid carcinoma(ATC), and to explore the value of multi-modality treatment in improving overall survival(OS) of ATC patients. Methods: Medical records including clinicopathological data of patients diagnosed with ATC at Cancer Hospital, Chinese Academy of Medical Sciences between 2001 and 2020 were retrospectively analyzed. The cohort were divided into surgery-only and multi-modality subgroups, and the latter included patients treated with surgery plus radiotherapy and/or medical therapy(including chemotherapy, target therapy and immunotherapy). Univariate survival analysis was conducted through Kaplan-Meier method, and multivariate survival analysis was performed using Cox proportional hazard model. Results: A total of 47 patients were included in the study, including 24 males and 23 females, with a median age of 63 years. After a median follow-up duration of 3.37 months, 42 patients died due to tumor recurrence or progression. The median OS of the cohort was 4.33 months. Univariate survival analysis demonstrated that symptoms of recurrent laryngeal nerve(RLN) involvement, distant metastasis, leukocyte elevation, and treatment modality were significantly associated with OS (P values all<0.05). Multivariate analysis showed that symptoms of RLN involvement(HR=2.49, 95%CI: 1.16-5.32, P=0.019), distant metastasis(HR=2.33, 95%CI: 1.06-5.16, P=0.036), and leukocyte elevation(HR=2.50, 95%CI: 1.16-5.40, P=0.020) were all independent risk factors for OS, while multi-modality therapy significantly prolonged OS compared with surgery alone(HR=0.22, 95%CI: 0.10-0.47, P<0.001). Conclusions: Among ATC patients, absence of symptoms of RLN invasion, normal leukocyte level and absence of distant metastasis at initial diagnosis are all independent protective factors for OS and multi-modality treatment can help to improve the prognosis.

Preoperative voice analysis and survival outcomes in papillary thyroid cancer with recurrent laryngeal nerve invasion.

To investigate the clinicopathological characteristics of papillary thyroid cancer (PTC) and identify risk factors for postoperative recurrence of PTC with recurrent laryngeal nerve (RLN) involvement. In total, 171 patients (112 women and 59 men, age: 18-80 years, and 65 patients aged ≥ 55) with T4a PTC with RLN involvement, treated at Beijing Tongren Hospital, Capital Medical University, from January 2006 to December 2020, were retrospectively examined. Clinicopathological characteristics, including voice analysis results, and survival outcomes were assessed. The Mann-Whitney U and Kruskal-Wallis H tests were used to analyze differences in acoustic parameters. The Kaplan-Meier method was used to calculate the overall survival (OS) and recurrence-free (RFS) rates. Univariate and multivariate Cox regression analyses were performed of the clinical data. The postoperative follow-up period ranged from 12 to 196 months (mean: 66.18 months). Of the 171 patients, 16 had recurrence and 8 died of thyroid-related diseases. The 5-year OS rate was 95.22%. The 5-year RFS rate was 89.38%. Jitter and shimmer were higher and maximum phonation time was shorter in patients with preoperative vocal cord paralysis (VCP) than in those without RLN involvement, and in those with RLN involvement but without preoperative VCP. Acoustic parameters were similar in patients with no preoperative VCP and those without RLN involvement. Voice analysis results did not differ between cases with RLN adhesion and RLN invasion. Univariate analysis showed that age at onset ≥ 55 years, preoperative RLN palsy, and esophageal invasion were risk factors for postoperative recurrence of PTC with RLN involvement. Multivariate analysis showed that onset age ≥ 55 years (OR 4.52, 95% confidence interval: 1.44-14.19, P = 0.010) was an independent risk factor for recurrence. PTC patients with RLN invasion can achieve good outcomes. Preoperative voice analysis may offer insights into RLN function. Age of onset ≥ 55 years is an independent risk factor for postoperative recurrence in T4a PTC patients.

Optimal Management of the Unilateral Recurrent Laryngeal Nerve Involvement in Patients with Thyroid Cancer.

Simple SummaryRecurrent laryngeal nerve (RLN) is the second most common structure invaded by primary or metastatic thyroid cancer. However, little is known about the optimal procedure for maintaining vocal function in patients with unilateral RLN involvement in thyroid cancer. This study aimed to evaluate various parameters of vocal function to establish the optimal management of thyroid cancer patients with unilateral RLN involvement. Based on our findings, we propose that for optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible. These findings may help improve management of RLN involvement in patients with thyroid cancer and ensure vocal function preservation.We aimed to determine the optimal management of recurrent laryngeal nerve (RLN) involvement in thyroid cancer. We enrolled 80 patients with unilateral RLN involvement in thyroid cancer between 2000 and 2016. Eleven patients with preoperatively functional vocal folds (VFs) underwent sharp tumor resection to preserve the RLN (shaving group). Thirty-three patients underwent RLN reconstruction with RLN resection (reconstruction group). We divided the reconstruction group into two subgroups based on preoperative VF mobility (normal-reconstruction and paralyzed-reconstruction subgroups). In the cases where RLN reconstruction was difficult, phonosurgeries including arytenoid adduction (AA), with or without thyroplasty type I, or nerve muscle pedicle implantation with AA were performed later (phonosurgery group). We evaluated and compared vocal function among the evaluated periods and different groups. Postoperative vocal function in the shaving and normal-reconstruction subgroups was favorable. There were no significant differences between the two groups. In the paralyzed-reconstruction and phonosurgery groups, postoperative vocal function was significantly improved, and vocal function in the paralyzed-reconstruction subgroup was significantly better than that in the phonosurgery group. For optimal management of unilateral RLN involvement in thyroid cancer, first, sharp dissection should be performed, and if this is impossible, a simultaneous RLN reconstruction procedure should be adopted whenever possible.

Clinical outcomes of T4a papillary thyroid cancer with recurrent laryngeal nerve involvement: a retrospective analysis

Preoperative vocal cord palsy (VCP) may indicate locally invasive papillary thyroid cancer (PTC); using this relationship, we evaluated the clinical outcomes and risk factors for recurrence in post-thyroidectomy T4a PTC patients with recurrent laryngeal nerve (RLN) involvement. We retrospectively investigated thyroidectomy patients, recorded their clinical factors, recurrence rate, and pathological findings, and analysed the relationship between recurrence rate and clinical factors. Of 72 patients, 37 (51%) had preoperative VCP and 35 (49%) had normal preoperative vocal cord movement with confirmed intraoperative RLN invasion. Tracheal and esophageal invasion was observed in 13 (18%) and 15 (21%) patients, respectively. Thyroid cancer recurred in 18 (25%) patients over 58 months, resulting in 2 (3%) deaths. Recurrence was not associated with surgical extent, organ invasion, enlarged tumour size, or lymph node infiltration (p > 0.05). The recurrence rate was significantly higher in patients with positive resection margins (p < 0.05). T4a PTC patients with RLN involvement showed a poor prognosis. The recurrence rate was not affected by preoperative VCP, intraoperative detection of RLN invasion, nerve resection, nerve preservation by shaving, lymph node metastasis, or tracheal or esophageal invasion. The most important prognostic factor for recurrence was a positive resection margin.

Immediate Surgery Might Be a Better Option for Subcapsular Thyroid Microcarcinomas.

For high-risk papillary thyroid microcarcinomas (PTMCs), immediate surgery is recommended. This study aimed to evaluate the location of PTMCs in the thyroid lobe and determine whether location is associated with an aggressive biology and the necessity of immediate surgery. This retrospective study included 288 patients who underwent initial surgery for PTMC. Clinical data were extracted. Subcapsular thyroid microcarcinomas (STMs) and nonsubcapsular thyroid microcarcinomas (NSTMs), distinguished by ultrasound, were compared in terms of tumour size, extrathyroidal extension, cervical lymph node metastasis, and multifocality. The preoperative ultrasound features predictive of recurrent laryngeal nerve (RLN) involvement were assessed. There were no statistical differences in tumour size (P = 0.985), multifocality (P = 0.866), lymph node metastases to the central compartment (P = 0.154), or lateral lymph node metastases (P = 0.929) between STM and NSTM groups. Macroscopic extrathyroidal extension was exclusively found in the STM group. For assessing RLN involvement, the sensitivity, specificity, and positive predictive value of the presence of an abnormal thyroid capsule margin between the STM and the presumed RLN course, assessed on preoperative ultrasonography images, were 100%, 43.3%, and 43.3%, respectively. Immediate surgery appears to be a better option than conservative treatment for these high-risk STM patients.

A child with multiple café au lait macules: Rare presentation of plexiform neurofibromatosis with facial dysmorphism, alopecia, proptosis, stridor, and limb length discrepancy

Multiple cafe au lait macules are one of the cornerstones in diagnosing neurofibromatosis Type 1 (NF 1). NF 1 is often a multisystem neurocutaneous disorder, plexiform NF being one of the most important variants of this phacomatosis. Here, a rare case of a 2.5-year-old male child without positive family history has been described who presented with multiple large cafe au lait spots, alopecia, dysmorphic facies, proptosis, protrusion and deviation of tongue, biphasic stridor, bilateral neck swelling, and abnormal gait due to foreshortened left leg. Magnetic resonance imaging revealed abnormal soft-tissue infiltration of cavernous sinus through sphenoid bone, retro-orbital, retropharyngeal, parapharyngeal spaces, floor of mouth, and encasement of unilateral neck vessels and compression over trachea. Indirect laryngoscopy revealed unilateral vocal cord palsy most likely due to recurrent laryngeal nerve involvement. Biopsy confirmed the diagnosis of NF. Pediatricians and dermatologists should be aware of syndromic causes and their varied presentations while encountering a child with multiple large cafe au lait spots.

Ortner’s Syndrome: A cause of unilateral vocal cord paralysis

Ortner’s syndrome is rare syndrome characterised by hoarseness of voice due to recurrent laryngeal nerve involvement in cardiovascular disease.

Vincristine-induced neuropathy in pediatric patients with acute lymphoblastic leukemia in Oman: Frequent autonomic and more severe cranial nerve involvement.

Vincristine (VCR) induced peripheral neuropathy is a common complication in children with acute lymphoblastic leukemia (ALL). A retrospective data analysis over an interval of 10 years (2006-2016) of all children with ALL seen at Sultan Qaboos University Hospital was carried out. Electronic medical records of eligible patients were reviewed. Patients with clinical evidence of neuropathy and abnormal nerve conduction studies (NCSs) were included in the study. Nineteen (nine females and 10 males) out of 103 pediatric patients developed VCR-related neuropathy, and their age ranged between 2.5 and 14 years. Symptoms started after 2-11 doses of VCR. All 19 patients had documented peripheral neuropathy on NCSs. The autonomic nervous system and cranial nerves affection was relatively common in our patients; two presented with bradycardia, two patients with unexplained tachycardia, and five had abdominal pain and constipation, complicated by typhlitis in two patients. One patient developed unilateral hearing loss. Two patients developed severe life-threatening cranial nerve involvement with bilateral ptosis and recurrent laryngeal nerve involvement presented as vocal cord paralysis, hoarseness of voice, frequent chocking, and aspiration episodes. Peripheral neuropathy was the commonest form of VCR-related neuropathy. Autonomic neuropathy was relatively common in our patients. Cranial neuropathy is a serious side effect of VCR that can be severe, involving multiple cranial nerves and needs prompt recognition and management. Concomitant administration of pyridoxine and pyridostigmine does not seem to protect against further neurological damage in some patients.

TCTAP C-208 Bilateral Pulmonary Artery Compressed by Tumor and Complicated with Severe Pulmonary Hypertension

### Patient initials or identifier number Tang QS, 45 year old gentleman ### Relevant clinical history and physical exam This 45 year-old man was a case of NSCLC, squamous cell carcinoma, stage IIIB, WGFR wild type, complicated with SVC syndrome, and recurrent laryngeal nerve involvement. He

English

ABSTRACT: The conventional technique of thyroidectomy normally requires a long skin incision and wide skin flaps on the anterior neck. The target of Minimal invasive surgery is to achieve the same results as those obtained with traditional surgery, less trauma, better postoperative course and improved cosmetic results. The aim of this Prospective Cohort study is to compare Small Incision (3.5-4cm) Thyroidectomy with conventional large incision Thyroidectomy with respect to post-op complications & Cosmesis. Most of the patients were in the age group 30-50yrs. There was no statistically significant difference between the two groups with respect to complications, which were Hematoma (6%), Seroma (25%), Hypocalcemia (52.5%)[Transient (37%), Permanent (15%)], Recurrent Laryngeal Nerve Involvement (33%) [Complete (6%)]. The scar in Small Incision surgery was cosmetically far better compared to the large incision Surgery & this difference was statistically significant. This technique not recommended in huge goiter, Retro-sternal goiter, thryroiditis and malignant thyroid. We believe that MINET can be an alternative to the classic approach in selected cases, but cannot be recommended as a standard therapy. Study on a large number of patients and longer follow up periods is recommended.

Vocal fold paralysis in the presence of thyroid disease: management strategies

The presentation of vocal fold palsy with associated goitre has historically been considered to be due to malignancy with recurrent laryngeal nerve involvement. In total, 830 consecutive patients who underwent thyroid surgery were reviewed. Patients with vocal fold paralysis and thyroid disease were examined to determine the aetiology of the paralysis. Nine patients were identified with new onset vocal fold paralysis prior to thyroid surgery. Six of the patients with recurrent laryngeal nerve paralysis had benign thyroid disease, and for three of the patients the paralysis was secondary to malignancy. Recurrent laryngeal nerve paralysis in the presence of thyroid disease is not pathognomonic for malignancy. The current literature may underestimate the association between vocal fold paralysis and benign thyroid disease. The paper also highlights the importance of recurrent laryngeal nerve preservation in patients who present with palsy and thyroid disease; the relief of benign compression often leads to complete recovery of recurrent laryngeal nerve paralysis.

AB1203 Juvenile dermatomyositis with extensive calcinosis: Progress with rituximab therapy

BackgroundJuvenile Dermatomyositis (JDM) is a rare, autoimmune condition of childhood which primarily involves the skin and muscles but can affect many organ systems due to widespread vasculopathy. The incidence in...

Descending necrotizing mediastinitis: Report of three cases and review of literature

Descending necrotizing mediastinitis (DNM) is a rare, severe, life-threatening suppurative infection of the fascial covering of mediastinal cavity. Oropharyngeal cavity is connected to the mediastinum with various fascial planes. The retropharyngeal space is called the dangerous space as through this fascial space infection from the mouth and neck rapidly spread to the mediastinum. Gravity and the negative intrathoracic pressure facilitate the spread of infection into the thoracic cavity. Common clinical presentations are fever, odynophagia, dysphonia, dry cough, neck swelling and chest pain. Computerized tomography of neck and chest will diagnose DNM early and it helps in the grading of the disease. Broad spectrum antibiotic therapy and fluid resuscitation with surgical drainage is essential therapeutic aspect. Combination of transcervical and transthoracic drainage is reported to have significantly more survival benefit than the trans-cervical drainage alone. Percutaneous and video-assisted mediastinoscopic drainage has obvious advantages compared with open surgical drainage. We report three cases of DNM, with recurrent laryngeal nerve involvement successfully treated by video-assisted thoracoscopy and percutaneous drainage.

Laryngeal electromyography in dysphonic patients with incomplete glottic closure

The lack of specificity in laryngoscopical examination requires that the diagnosis of superior laryngeal and recurrent laryngeal nerve involvement be carried out with the aid of electromyography. ObjectiveThis study aims to assess the electrophysiological function of the superior and inferior laryngeal nerves by measuring the electrical activity of the muscles they innervate in dysphonic patients with incomplete closure of the vocal folds during phonation. MethodThirty-nine patients with incomplete glottic closure were enrolled in a prospective study and had their cricothyroid, thyroarytenoid, and lateral cricoarytenoid muscles examined bilaterally through electromyography. Insertion activity, electrical activity at rest (fibrillation, positive wave and fasciculation) and during muscle voluntary contraction (recruitment, amplitude, potential length and latency between electrical activity and phonation) were measured. ResultsNo altered test results were observed for parameters insertion activity and electrical activity at rest. None of the patients had recruitment dysfunction. The mean electrical potential amplitude values were within normal range for the tested muscles, as were potential durations and latency times between the onset of electrical activity and phonation. ConclusionNo signs of denervation were seen in the thyroarytenoid, cricothyroid, and lateral cricoarytenoid muscles of the studied patients.

An Unusual cause for Vocal Cord Palsy: Case Record

ABSTRACT Objectives We report a case of granulomatous lesion infiltrating the recurrent laryngeal nerve to produce vocal cord palsy, the diagnostic dilemma posed by it and its management. Materials and methods Clinical documentation of a 52-yearold man who presented with hoarseness of 3 months duration is presented. The clinical examination revealed immobile left vocal cord and a bulky (Lt) ventricular band with a suspicious ulcer on its posterior aspect. A computed tomographic (CT) scan of the neck and chest revealed a 1 × 1 cm nodular lesion in the tracheoesophageal groove. Conclusion Causes for vocal cord palsies are wide ranging and predominantly include malignant infiltration of the vagus or the recurrent laryngeal nerve. The anatomical site of involvement can be clinically and radiologically assessed with ease. Vocal cord palsy due to recurrent laryngeal nerve involvement by a granulomatous lesion is an unreported phenomenon and we believe that this is the first case to be reported in literature. Summary An unusual case of recurrent laryngeal nerve granuloma is reported with the diagnostic dilemma that it presented. This was successfully managed by surgical excision and postoperative antituberculosis treatment. How to cite this article Varghese BT, Sebastian P, Divya GM. An Unusual cause for Vocal Cord Palsy: Case Record. Int J Phonosurg Laryngol 2012;2(2):88-90.

Surgical treatment for well-differentiated thyroid carcinoma invading the larynx,trachea,esophagus and hypopharynx

Objective:To explore the surgical treatment for well-differentiated thyroid carcinoma(WDTC) invading the larynx,trachea,esophagus and hypopharynx. Methods: Primary tumor resection was performed in 17 patients with advanced WDTC.All the 17 cases had laryngotracheal involvement and received different kinds of surgical treatment: including 14 receiving local shaving-off,wedge tracheal resection with direct suture,window tracheal resection with sternocleidomastoid myoperiosteous flap reconstruction,sleeve tracheal resection with tracheal anastomosis or tracheal reconstruction by forearm free skin flap,and 3 receiving total laryngectomy or near-total laryngectomy. Eleven cases with esophagus and hypopharynx involvement received muscular layer resection or esophageal and hypopharynx partial resection with pectoralis major myocutaneous flap reconstruction. For 12 cases with recurrent laryngeal nerve involvement,9 were treated by nerve decompression,nerve resection combined with one-stage arytenoid within-shift and/or recurrent laryngeal nerve transposition,3 by simple laryngectomy. Results: The patients were followed up for 1 to 12 years. Sixteen patients survived and one died of tumor metastasis. The 5-year survival rate was 93.3%; the post-operation complication rate was 23.5%.Tumor relapses were found in 2 cases who had undergone local shaving-off or partial cervical trachea resection. The voice quality of the 9 patients receiving recurrent laryngeal nerve decompression or voice rehabilitation was greatly improved,and 5 of them had normal voice. Conclusion: The curative rate and quality of life of WDTC patients with extrathyroidal extension can be improved by one-stage resection and reconstruction. Operation modes should be chosen according to the location, involvement of tumor, the invasion of recurrent laryngeal nerve and the disease course. Operation is invasive and reconstruction is a complicated process, with many complications.