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Vocal cord paralysis after open-heart surgery.

Abdel Latif Hamdan1, Roger V Moukarbel, Firas Farhat

  • 1Department of Otolaryngology -- Head and Neck Surgery, American University of Beirut, Beirut, Lebanon. hb03@aub.edu.lb

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 5, 2002
PubMed
Summary

Right vocal cord paralysis after open-heart surgery is rare but serious. Transient hoarseness can signal recurrent laryngeal nerve injury, requiring physician attention and patient follow-up.

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Area of Science:

  • Cardiology
  • Neurology
  • Otolaryngology

Background:

  • Vocal cord paralysis is a known complication of neck surgery.
  • Injury to the recurrent laryngeal nerve (RLN) can occur in the chest, more commonly on the left due to its longer intrathoracic course.
  • Right vocal cord paralysis post-open-heart surgery is infrequently reported.

Purpose of the Study:

  • To review potential mechanisms of right recurrent laryngeal nerve injury during open-heart surgery.
  • To alert physicians to the clinical significance of this complication.
  • To emphasize that hoarseness post-surgery may indicate RLN injury, not just laryngeal edema.

Main Methods:

  • Literature review of reported cases and proposed injury mechanisms.
  • Analysis of anatomical considerations for the right recurrent laryngeal nerve during cardiac procedures.

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  • Discussion of clinical implications and diagnostic considerations.

    • Main Results:

    • Several mechanisms can injure the right RLN during open-heart surgery, including central venous catheterization, esophageal traction, endotracheal intubation trauma, endotracheal tube cuff compression, nasogastric tube insertion, sternotomy/sternal retraction, direct cardiac manipulation, and hypothermic injury.
    • Transient hoarseness is a key clinical sign of potential RLN injury.
    • Overlooking this complication can lead to dysphonia, ineffective cough, and aspiration.

    Conclusions:

    • Right recurrent laryngeal nerve injury is a rare but significant complication of open-heart surgery.
    • Prompt recognition of hoarseness as a potential sign of RLN injury is crucial.
    • Close patient follow-up is necessary to manage potential long-term sequelae, including the need for surgical intervention if recovery does not occur.