Unilateral Vocal Cord Paresis Research Articles

Surgical complications of vagus nerve stimulation surgery: A 14-years single-center experience

IntroductionVagus nerve stimulation (VNS) is the most frequently used neuromodulation treatment for Drug-Resistant Epilepsy (DRE) patients. Complications of VNS surgery include surgical site infection and unilateral vocal cord paresis. Complication rates vary across studies. Research questionWhat is the safety profile of VNS related surgeries? Materials and methodsRetrospective cohort study using patient files of DRE-patients who had undergone primary implantation of a VNS-system, replacement of the VNS pulse generator, replacement of the lead, replacement of both pulse generator and lead, or VNS removal surgery in the Maastricht UMC+. Multiple Imputation was used for missing data. Univariable and multivariable logistic regression analysis were performed to analyze possible risk factors, in case of a small sample size, an independent-samples t-test and Fisher's exact test or Pearson's X2-test were used. The complication rate was calculated as percentage. ResultsThis study included a total of 606 VNS surgical procedures, leading to 67 complications of which 3 permanent complications. Complication rate after primary implantation was 13.4%; 2,5% for pulse generator replacement; 21.4% for lead revision and 27.3% for complete VNS removal. No statistically significant results were found when analyzing the results of adults and children <18 years separately. Discussion and conclusionComplication rates of VNS-related surgeries in our own institutional series are low and comparable to previously reported series. VNS surgery is a relatively safe procedure. The complication rate differs per type of surgery and mean surgery duration was longer for patients with complications after lead revision surgery compared to patients without complications.

441. COMBINING LARYNGEAL ULTRASONOGRAPHY (LUSG) WITH VOICE ASSESSMENT OR INTRA-OPERATIVE NERVE MONITORING RESULTS ACCURATELY CONFIRMS NORMAL VOCAL CORD FUNCTION AFTER ESOPHAGECTOMY

Abstract Background Conventional diagnosis of vocal cord paresis (VCP) after esophagectomy relies on flexible laryngoscopy (FL), which is invasive. As most patients had normal post-operative VC function, a non-invasive alternative such as laryngeal ultrasonography (LUSG) may avoid unnecessary FL. LUSG was well-known to be accurate for post-thyroidectomy VC evaluation, but its accuracy following esophagectomy was unclear. This prospective study assessed the feasibility and accuracy of LUSG to evaluate VC function on day-1 after esophagectomy. Methods Consecutive patients from a tertiary teaching hospital who underwent elective esophagectomy were prospectively recruited. All patients received FL and LUSG pre-operative and on post-operative Day-1, each performed by an independent, experienced blinded assessor. Exclusion criteria include pre-operative VCP and lost to VC evaluation at any time points. The primary outcome was the accuracy of LUSG in the diagnosis of VCP on Day-1 post-esophagectomy. The accuracy of intermittent intra-operative nerve monitoring (IIONM) and voice assessment (VA) after surgery for the diagnosis of VCP were also analyzed. Results Twenty-six patients were eligible for analysis. The median age was 70 years (66–73). Majority were male (84.6%) and had squamous cell carcinoma. (88.5%). Twenty-five (96.2%) received three-phase esophagectomy. Twenty-four (96%) had anastomosis at the neck at the same stage. There were three (11.5%) temporary and one (3.8%) permanent unilateral VCP. Sensitivity, specificity and accuracy of LUSG were 75.0%, 100.0% and 98.1% respectively, which were superior to IIONM alone (50%, 90.3%, 87.9%) or VA alone (50%, 90.9%, 84.6%). Combining LUSG with VA or IIONM improved sensitivity and negative predictive value to 100.0% and could avoid 77% FLs. Conclusion LUSG is an accurate method to evaluate VC function in the early post-operative period after esophagectomy. Combining LUSG with VA or IIONM results accurately confirms normal VC function after esophagectomy, and can avoid a majority of FLs.

A Case Report of Early Surgical Intervention for Diffuse Idiopathic Skeletal Hyperostosis of the Cervical Spine: Challenges in Management

Background and Importance: Diffuse idiopathic skeletal hyperostosis (DISH) can compress the trachea and esophagus when located in the cervical spine. In this report, we investigated whether it is preferable to perform the early surgical intervention in symptomatic patients or to wait and administer supportive care and perform late surgical intervention regardless of whether symptoms progress or not. Case Presentation: We present the case of a 70-year-old patient with diffuse idiopathic skeletal hyperostosis (DISH) causing significant dysphagia and unilateral vocal cord paresis, resulting in dyspnea and stridor. Imaging diagnostics revealed large osteophytes anterior to the cervical spine from C3 to C6 compressing the cervical spine. Significant clinical improvement was observed following the anterior resection of the patient's osteophytes. Conclusion: In order to achieve higher success and less recurrence, it is preferable to perform surgical intervention earlier in the disease's progression. However, more studies are necessary to confirm this because most of the present results are from case report articles and have less evidence.

A Prospective Study Evaluating the Feasibility and Accuracy of Post-operative Laryngeal Ultrasonography (LUSG) in Assessment of Vocal Cord Function After Esophagectomy.

Vocal cord paresis (VCP) is a serious complication after esophagectomy. Conventional diagnosis of VCP relies on flexible laryngoscopy (FL), which is invasive. Laryngeal ultrasonography (LUSG) is non-invasive and convenient. It has provided accurate VC evaluation after thyroidectomy but it is unclear if it is just as accurate following esophagectomy. This prospective study evaluated the feasibility and accuracy of LUSG in VC assessment on day-1 after esophagectomy. Consecutive patients from a tertiary teaching hospital who underwent elective esophagectomy were prospectively recruited. All received pre-operative FL, and post-operative LUSG and FL on Day-1, each performed by a blinded, independent assessor. The primary outcomes were feasibility and accuracy of LUSG in the diagnosis of VCP on Day-1 post-esophagectomy. The accuracy of voice assessment (VA) was analyzed. Twenty-six patients were eligible for analysis. The median age was 70years (66-73). Majority were male (84.6%). Twenty-five (96.2%) received three-phase esophagectomy. Twenty-four (96%) had same-stage anastomosis at the neck. Three (11.5%) developed temporary and one (3.8%) developed permanent unilateral VCP. Overall VC visualization rate by LUSG was 100%; sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy of LUSG were 75.0%, 100%, 100%, 98.0%, 98.1% respectively, and superior to VA. Combining LUSG with VA findings could pick up all VCPs i.e. improved sensitivity and NPV to 100%. LUSG is a highly feasible, accurate and non-invasive method to evaluate VC function early after esophagectomy. Post-operative FL may be avoided in patients with both normal LUSG and voice.

Feeding Therapy Treatments for Infants With Unilateral Vocal Cord Paresis.

No evidence-based treatment protocol currently exists for infants with vocal cord paresis (VCP). To assess the impact of feeding position on feeding success among infants with unilateral VCP and examine other variables that may be associated with feeding success. Retrospective descriptive study. Midwestern pediatric hospital serving rural and urban populations. Sixty-seven infants age <1 yr diagnosed with unilateral VCP by otolaryngologist while inpatient. Bottle or breastfeeding without the use of a thickening agent at discharge and without readmission for feeding difficulties ≤3 mo of discharge was considered feeding success. Chart review was completed for 67 infants with unilateral VCP. Infants fed in side lying were more likely to feed without use of a thickened liquid than infants fed in upright (70% vs. 17%; p = .01). Infants who had patent ductus arteriosus (PDA) ligation and infants who were premature were more likely to need thickener and to be readmitted for feeding difficulties. Further study is required to investigate the use of side-lying position versus upright position for feeding infants with VCP. Using the side-lying position allowed more infants to feed without thickener agents, and patient characteristics, including history of PDA ligation and prematurity, correlated with the need for thickened liquids and readmission. Consensus on the safety and efficacy of thickening breast milk is limited, so this information may allow more infants to breastfeed or drink expressed breast milk safely by bottle. It also provides medical providers information that can possibly prevent readmissions. What This Article Adds: The results of this study can inform occupational therapy feeding practice through use of the side-lying position, as well as being aware of patient characteristics that are correlated with increased feeding difficulties.

Idiopathic Brachial Plexopathy Presenting with Unilateral Vocal Cord Paresis (P9-13.003)

Idiopathic Brachial Plexopathy Presenting with Unilateral Vocal Cord Paresis (P9-13.003)

A Cerebrovascular Accident Presenting With Bilateral Vocal Cord Paresis

Diagnosing a stroke requires careful attention to clinical indicators on physical exam, especially the more subtle manifestations of cerebellar lesions. An 85-year-old male with vascular risk factors and new-onset atrial fibrillation was admitted for left upper extremity weakness, headaches, and tremors. The patient developed stridor during hospitalization and was found to have a new cerebellar infarct with hemorrhagic transformation on computed tomography (CT) of the head, with laryngoscopy showing bilateral vocal cord paresis. While strokes outside of the cerebellum are a known cause of unilateral vocal cord paresis, cerebellar strokes are a rare culprit and rarely cause bilateral cord paresis. Consideration beyond the more common pulmonary and iatrogenic causes of vocal cord paresis should be considered, with particular attention to stroke.

Unilateral vocal cord paresis following excision of a large esophageal duplication cyst via median sternotomy in a neonate

Abstract A newborn, prenatally diagnosed with a cystic mass, possible esophageal duplication cyst, of the upper posterior mediastinum was admitted to our department with symptoms of worsening respiratory distress. A median sternotomy and complete cyst resection were performed, yet worsening respiratory distress was a major concern in the immediate postoperative period which led to further hospitalization and investigations. Surgical resection is the gold standard in therapy for esophageal duplication cysts as reported by all authors that have published such cases. Resection is considered the safest approach to prevent a patient from complications such as hemorrhage, infection, perforation and malignant transformation, yet very few data are published regarding operative complications and pitfalls.

Blunt Complete Tracheal Transection

A 25-year-old construction worker was hanged accidentally by his shawl. He presented to the emergency department with neck contusion, subcutaneous emphysema, and voice change followed by respiratory distress which indicated oro-tracheal injury. The tracheal injury was confirmed by computed tomography (CT) and bronchoscopy. Intra-operatively, a tracheostomy tube was placed followed by repair of a tear in the posterior membranous portion and approximation of the separated crico-tracheal ends. The postoperative course was uneventful, except that unilateral vocal cord paresis was managed medically.

Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors

Background: Vocal cord paresis (VCP) may occur following high intensity focused ultrasound (HIFU) of thyroid nodules. We hypothesised its occurrence relates to the distance of the focus point (FP) of the HIFU beams from the recurrent laryngeal nerve (RLN) and the thermal power that this point received. Their relationships were examined.Methods: One hundred and three patients who underwent HIFU for symptomatic benign thyroid nodule from October 2015 to March 2017 were analysed. All treatment images were captured and were later watched by 2 reviewers to identify three FPs closest to the tracheoesophageal groove (TEG) on transverse sonographic view. TEG was taken as the RLN position. After identifying these FPs, their distance (mm) from the TEG, thermal power (W) used and depth from skin (mm) were recorded. These parameters were compared between those with and without VCP. VCP was defined as a cord with reduced or no movement.Results: Four (3.9%) patients suffered from a unilateral VCP afterwards but they all recovered fully within 6 weeks. There were no significant differences in baseline characteristics and treatment efficacy between the two groups. The distance from TEG (OR = 1.706, 95%CI = 1.001 to 2.915, p = 0.050) was the only significant factor for VCP. None of the other variables including thermal power were significant.Conclusions: The incidence of VCP was 3.9% (4/103) and they completely recovered within 6 weeks. The distance between the FP and the TEG was the only related factor for VCP. The safe distance between FP and TEG should be ≥1.1 cm.

Voice therapy and assistive techniques in voice disorders caused by unilateral vocal cord pareses

Dysphonias due to primary neurogenic disorders are a group of voice disorders that can be caused by both central and peripheral disorders of the larynx innervation. There are numerous causes leading to paralysis of superior and/or inferior laryngeal nerves, particularly of the inferior laryngeal or recurrent nerve. VOICE THERAPY IN UNILATERAL VOCAL CORD PARESIS: Vocal therapy is an integral part of the conservative treatment. Specific methods are applied to individual vocal problems, while the non-specific ones are applied to a number of dysphonias. Non-specific methods are further divided into integrated and focused vocal methods. Integrated methods treat the voice and speech disorders as a unified entity of all quality and segments of voice and speech. Focused non-specific methods treat the segments and the quality of voice and speech individually. ASSISTIVE TECHNIQUES IN VOICE DISORDERS CAUSED BY UNILATERAL VOCAL CORD PARESIS: Digital compression of the larynx by Seeman includes the treatment of voice with compression of the thyroid cartilage, thus moving the paralyzed and healthy vocal cord medially and upwards, and medially and downwards, respectively. This leads to the proper occlusion of vocal cords because in these conditions the paralyzed vocal cord is lower than the healthy one. According to the theoretical assumption, when the head anc neck are rotated to one or the other side, the anatomic relations in the neck are change and thus the vocal cords are brought into contact with the resulting reduction of the gap between them and the reduced air flow. Studies assessing the efficiency of different methods of vocal therapy are scarce bearing in mind the importance of vocal therapy and the fact that many patients refuse surgical treatment. Research on the efficiency of assistive techniques in phoniatric rehabilitation of patients with unilateral vocal cord paresis yields conflicting results. However, assistive techniques are useful practical methods in vocal rehabilitation of these patients.

Index of Suspicion in the Nursery

A term male infant is transferred to the NICU for persistent hypoglycemia at age 3.5 hours. The infant had a blood sugar level of 21 mg/dL at age 3 hours and despite refeeding 20 mL of 20 calories per ounce of formula, his blood glucose level remained at 20 mg/dL at 3.5 hours. The infant was born via cesarean delivery for a nonreassuring heart rate tracing to a 19-year-old G1P 0 African-American mother. All prenatal laboratory results were negative, including an oral glucose tolerance test. Prenatal ultrasonography was performed during the second trimester and showed no gross fetal anomalies other than the presence of a two-vessel cord. The infant cried spontaneously at birth and had some transient respiratory distress. The infant weighs 2,960 g (50th percentile) with a length of 48 cm (50th percentile) and a head circumference of 32.5 cm (25th–50th percentile). Results of the physical examination are normal except for a small penis (stretched penile length of 1.5 cm, width of 0.6 cm) and an undescended left testicle. Blood glucose levels below 40 mg/dL persist despite two boluses of 10% dextrose and administration of continuous dextrose infusion with a glucose infusion rate of ∼5 mg/kg per minute. Glucose levels above 40 mg/dL are eventually achieved with a glucose infusion rate of 8 mg/kg per minute. The pediatric endocrinology service was consulted on the second day for persistent hypoglycemia. A 3,490-g term male infant is born to a 20-year-old primigravida mother. She received good prenatal care, and her pregnancy was uncomplicated. Antenatal screening for human immunodeficiency virus, hepatitis B, and syphilis were negative, and she had immunity against rubella. Results of the patient’s cervical culture were positive for group B streptococcus, but she received adequate intrapartum penicillin prophylaxis before delivery. There was no abnormality noted on the fetal cardiotocography. …

Immobilités laryngées unilatérales après chirurgie de la glande thyroïde

The authors studied a cohort of 154 patients with unilateral vocal cord paresis following thyroidectomy, analyzing the pathogenesis, symptomatology, spontaneous evolution, and management of this complication. This retrospective study distinguished between vocal cord paresis due to recurrent laryngeal nerve injury or due to injury of the cricoarytenoid articulation. We assessed the influence multiple variables on therapeutic management. The results and complications of currently-employed surgical techniques to remedy unilateral vocal cord paresis were defined. Injury to the recurrent laryngeal nerve was the cause of vocal cord paresis in 98% of cases; injury to the cricoarytenoid articulation accounted for only 2% of cases. When the recurrent laryngeal nerve had not been actually transected, spontaneous recovery of vocal cord function occurred in 36% of cases. No spontaneous recovery was noted when the nerve had been divided. The interval to recovery of cord function ranged from 2 to 15 months (median: 4 months). Spontaneous recovery of vocal cord function had occurred in 90% of these patients by the 9th postoperative month. Three factors significantly influenced the decision to perform a median transposition of the injured vocal cord: known transection of the recurrent laryngeal nerve, the interval to consultation with an ENT specialist, and the severity of dysphonia. Medial transposition of the injured vocal cord resulted in an immediate improvement in the quality of voice and speech with no major complications. Unilateral vocal cord paresis occurring after thyroidectomy is not always symptomatic and is not uniformly due to injury of the recurrent laryngeal nerve. Management does not always require surgical reintervention. The practical and medico-legal consequences of these injuries are discussed.

Minimally Invasive Video-assisted Thyroidectomy: 2 Yrs Work

Objective The minimally invasive video-assisted thyroidectomy (MIVAT) technique was first pioneered in Europe in the 1990s. It has shown to have comparable results to traditional thyroidectomy and additional advantages such as better cosmetic results as well as faster recovery. This project aims to analyze the results from the MIVAT procedure utilizing a 2-person technique over the initial 2 years of inception at an academic training center. Methods Retrospective review of 170 cases between May 2006 and September 2007 at LLUMC. The demographic and clinical data collected includes age, sex, incision, operative times, hospitalization, identification of recurrent laryngeal nerves, pathology, size of the dominant nodule and entire gland, and postoperative complications. Results 23 male and 147 female patients underwent MIVAT by a single surgeon; of those, 59 total thyroidectomies and 111 hemithyroidectomies were performed. The mean incision length was 3.5cm. The average weight/volume on pathology was 19.25g/19cm3, 21.03g/22cm3 and 31.29g/40cm3 for the right lobe, left lobe, and entire gland respectively. Average nodule size was 3.6cm3. The mean surgical time was 91.7 minutes and the mean blood loss was 31cc. Average hospitalization stay was 1.43 days. 17 patients experienced temporary hypocalcemia, and 1 patient remained hypocalcemic for more then 6 months. Two patients experienced transient pitch problems, 7 patients experienced temporary unilateral vocal cord paresis, and 1 patient experienced mild diplophonia. Conclusions While enabling smaller surgical access for thyroidectomy, 2-surgeon technique MIVAT can be performed safely and quickly. Voice problems were the most common complications that usually resolved in 8 weeks.

The Use of Polydimethylsiloxane for Injection Laryngoplasty

Injuries of the recurrent laryngeal nerve with consecutive vocal cord paralysis is a typical complication in chest, esophageal, thyroideal, and neck surgery. Glottic insufficiency secondary to such a lesion can be treated by endolaryngeal vocal cord augmentation (injection laryngoplasty). Many different substances have been used, often showing complications or disadvantages. This study reports on the use of injectable polydimethylsiloxane (PDMS), with special regard to the long-term results. In this prospective study, 21 patients with unilateral vocal cord paralysis underwent injection laryngoplasty using PDMS at a volume of 0.5-1.0 ml. Preoperatively, 6 weeks and 12 months after the injection the following parameters concerning patients' voice were evaluated: Glottic closure by videolaryngostroboscopy, maximum phonation time, voice range, voice dynamic, jitter, shimmer, noise-to-harmonic-ratio, and roughness, breathiness, and hoarseness (RBH). In addition, patients were asked to give their own evaluation of how satisfied they felt with their voice and of the handicaps it caused them. Postoperatively an improvement was evident in all the parameters that were investigated, and this significant improvement was still in evidence for most of the parameters more than one year after the injection. In our study no complications were observed more than one year after injection. PDMS is a safe substance for injection laryngoplasty in unilateral vocal cord paresis. Objective and subjective parameters confirm its effectiveness. It is suitable for obtaining satisfying results in the reestablishment of the patient's voice and communication ability.

Incidence of Vocal Cord Paralysis With and Without Recurrent Laryngeal Nerve Monitoring During Thyroidectomy

To compare the incidence of postoperative vocal cord paresis or paralysis in a cohort of patients who underwent thyroidectomy with and without continuous recurrent laryngeal nerve (RLN) monitoring by a single senior surgeon. We hypothesize that continuous RLN monitoring reduces the rate of nerve injury during thyroidectomy Retrospective medical chart review. Academic tertiary care medical center. A total of 684 patients (1043 nerves at risk) who underwent thyroid surgery under general anesthesia. Incidence of vocal cord paresis or paralysis in patients who underwent thyroid surgery with continuous RLN monitoring vs those undergoing surgery without continuous RLN monitoring. The incidence of unexpected unilateral vocal cord paresis based on RLNs at risk was 2.09% (n = 14) in the monitored group and 2.96% (n = 11) in the unmonitored group. This difference was not statistically significant. The incidence of unexpected complete unilateral vocal cord paralysis was 1.6% in each group. Two of the 5 paralyses in the unmonitored group and 7 of the 11 paralyses in the monitored group had complete resolution. Monitoring of the RLN does not appear to reduce the incidence of postoperative temporary or permanent complete vocal cord paralysis. There appeared to be a slightly lower rate of postoperative paresis with RLN monitoring, but this difference was not statistically significant.

Capsular genu syndrome

We report 5 patients with unilateral infarct and 1 with hemorrhage limited to the genu of the internal capsule. The most prominent finding was contralateral facial and lingual hemiparesis with dysarthria. Three patients also showed unilateral mastication-palatal-pharyngeal weakness, and 1 had unilateral vocal cord paresis. Mild limb involvement was limited to hand weakness in 4 patients. Our findings suggest that the majority of motor corticopontine and corticocobulbar fibers are located in the genu of the internal capsule. The faciolingual syndrome and its variants are highly suggestive of capsular genu stroke.

Vocal Cord Paralysis

The information presented in this article demonstrates that unilateral or bilateral vocal cord paresis or paralysis in infants and children is difficult to diagnose and difficult to manage. In an attempt to provide the otolaryngologist with a concise set of relevant guidelines, the following rules for management are presented here. 1. Suspect bilateral abductor vocal cord paralysis (BAVP) when a neonate or infant presents with high-pitched inspiratory stridor and evidence of airway compromise. Factors that should increase the suspicion of BAVP include associated Arnold-Chiari malformation; congenital anatomic abnormality involving the mediastinum (for example, tracheoesophageal fistula, vascular ring, other vascular anomalies); dysmorphic syndromes, especially those involving brainstem dysfunction; and manifest findings indicative of neuromuscular disorder. The neonate or infant with Arnold-Chiari malformation and inspiratory stridor has bilateral abductor vocal cord paralysis until proven otherwise. 2. Suspect unilateral vocal cord paresis or paralysis in an infant or child with hoarse voice, low-pitched cry, or breathy cry or voice. The infant who develops mild stridor and hoarse cry following surgical repair of a patent ductus arteriosus or tracheoesophageal fistula has a unilateral vocal cord paralysis until proven otherwise. 3. Direct laryngoscopy with the flexible fiberoptic nasopharyngolaryngoscope and photodocumentation using a videocassette recorder offers the best method for diagnosis of vocal cord paresis or paralysis. Additional diagnostic studies that may be helpful include radiographic studies, CT scan, MRI scan, electromyography of the larynx, and, in older children, stroboscopy. 4. In using a flexible direct laryngoscope be careful not to interpret all motions of the vocal cords or arytenoids as evidence to preclude the diagnosis of vocal cord paralysis or paresis and be careful not to mistake the anterior intraluminal portion of a normal cricoid for an "anterior glottic web." 5. Tracheotomy is often required in order to assure adequate airway during infancy for children with BAVP. However, with the advent of sophisticated cardiorespiratory monitoring equipment and methods for monitoring blood oxygen and carbon dioxide levels, tracheotomy can be delayed until attempts have been made to improve the adequacy of the airway with neurosurgical intervention or other procedures.(ABSTRACT TRUNCATED AT 400 WORDS)

Idiopathic Paresis of the Recurrent Laryngeal Nerve: New Treatment with Cortisone Preparations

In his article, Surgical Decompression of the Recurrent Laryngeal Nerve in Idiopathic Unilateral Vocal Cord Paresis (Ann. Otol. 70:451-462, 1961), J. H. Ogura has made a study from the anatomical point of view of those sites in the course of the recurrent nerve which may be predisposed to physiological compression, and so to blocking of the nerve. He has arrived at an interesting and—as everything seems to indicate—a very fruitful conclusion, i.e., that the region of the cricothyroid articulation is one of the zones in which the recurrent nerve may be exposed to compression of this nature. In particular, the anterior division of this nerve, running in a region between rigid structures, is especially exposed to blockade. In 4 selected cases of paresis of the recurrent nerve, Ogura performed a subperichondral resection of the inferior cornu of the thyroid cartilage. A rapid restitution of nerve function ensued in 2 cases,

Surgical decompression of the recurrent laryngeal nerve in idiopathic unilateral vocal cord paresis. preliminary report

The LaryngoscopeVolume 71, Issue 12 p. 1577-1579 Article Surgical decompression of the recurrent laryngeal nerve in idiopathic unilateral vocal cord paresis. preliminary report Joseph H. Ogura M.D., Joseph H. Ogura M.D.Search for more papers by this author Joseph H. Ogura M.D., Joseph H. Ogura M.D.Search for more papers by this author First published: December 1961 https://doi.org/10.1288/00005537-196112000-00011AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume71, Issue12December 1961Pages 1577-1579 RelatedInformation