Recurrent laryngeal nerve paralysis after prolonged neck dissection under general anesthesia with endotracheal...

Recurrent laryngeal nerve (RLN) paralysis is a rare but clinically significant complication of general anesthesia associated with endotracheal intubation. We report a case of unilateral RLN paralysis that occurred after prolonged neck dissection under general anesthesia. A 77-year-old male patient with a history of hypertension, dyslipidemia, and myocardial infarction underwent right neck dissection and segmental mandibulectomy for mandibular gingival cancer. Tracheostomy was performed after general anesthesia induction, and a spiral endotracheal tube was inserted with the cuff pressure continuously maintained at 28 cmH₂O. The surgery lasted for over 15 h, with the patient's neck rotated to the right. No intraoperative complications were observed. Postoperatively, the patient presented with hoarseness and was diagnosed with left RLN paralysis. Fiberoptic examination revealed markedly reduced left arytenoid movement with incomplete glottic closure. Improvement in arytenoid mobility was noted on postoperative day (POD) 25 and phonation returned to normal by day 54. The likely mechanisms involve prolonged intubation, neck rotation, and compressive ischemia of the contralateral RLN. This case underscores the importance of careful cuff pressure monitoring and minimization of neck rotation during prolonged surgery to prevent this rare but potentially disabling complication.