Vocal cord paralysis after laryngeal mask airway ventilation

The laryngeal mask airway (LMA) is being used with increasing frequency since its introduction into the United States in 1991. Currently, the LMA is being used in the United States in approximately one third of all operations or greater than 100 million surgeries. In Britain, where it was first introduced for use in 1988, the LMA is estimated to be used in up to 50% of cases. Not only has its use in elective cases increased, but the scope of indications for the LMA has also grown. Its use in emergent and difficult airway management has increased, and new LMA products have been introduced to address the limitations of the classic model. As the LMA has increased in popularity, however, so has the incidence of LMA-related complications. Cases of mucosal trauma, hematoma, tongue cyanosis, arytenoid dislocation, and lingual, hypoglossal, and recurrent laryngeal nerve paralyses have been documented in various anesthesia journals. Reports of these injuries are sparse in the otolaryngology literature. As otolaryngologists who will manage the sequelae of LMA-related injuries, we must remain cognizant of potential problems and their underlying mechanisms. We report a case of unilateral vocal cord paralysis, which required operative repair after the use of an LMA. We review the existing case reports, propose mechanisms of injury, and discuss practical applications of our findings.