Recurrent laryngeal nerve paralysis associated with thoracic aortic aneurysm

Area of Science:

• Cardiovascular Surgery
• Otolaryngology
• Thoracic Surgery

Background:

• Vocal cord dysfunction is associated with thoracic aortic aneurysms (TAA).
• Recurrent laryngeal nerve paralysis (RLNP) is a known complication.
• Understanding the natural history and mechanisms of RLNP in TAA is crucial.

Purpose of the Study:

• To define the natural history of RLNP associated with TAA.
• To propose mechanisms for RLNP development in both operated and non-operated TAA.
• To evaluate functional recovery and treatment needs for RLNP in TAA patients.

Main Methods:

• Retrospective review of 168 TAA cases.
• Analysis of patient data including aneurysm type, surgical history, and vocal cord function.
• Correlation of RLNP incidence and recovery with TAA classification and treatment.

Main Results:

• 5% of TAA patients presented with hoarseness due to RLNP, primarily in Type I aneurysms.
• RLNP occurred in 12% of patients undergoing TAA repair.
• Vocal cord function recovery varied significantly by TAA type, with higher recovery in Type III than Type I repairs.
• 66% achieved sufficient glottic competence without intervention; 27% required Teflon injection for dysphonia or aspiration.
• 17% of patients with vocal cord paralysis recovered spontaneously within 12 months.

Conclusions:

• RLNP is a significant complication of TAA, particularly Type I.
• Surgical repair of TAA can lead to or exacerbate RLNP, with variable recovery rates.
• Anatomical considerations are key to understanding and potentially mitigating RLNP in TAA management.