Laryngeal Injuries Following General Endotracheal Anesthesia: A Case Series

Endotracheal intubation can cause laryngeal injury, with clinical presentation ranging from transient hoarseness to persistent vocal cord immobility. This study examines the incidence, clinical features, and outcomes of post-intubation laryngeal injuries following procedures traditionally considered low risk for such complications.

We conducted a retrospective review of adult patients who underwent tracheal intubation for surgical procedures between May 1, 2018, and December 31, 2024, and subsequently presented with postoperative laryngeal injury-related symptoms. Patients who underwent cardiothoracic, thyroid, parathyroid, or anterior cervical spine procedures were excluded. We reviewed patient demographics, airway and intubation characteristics, treatments, and clinical outcomes.

Among 267 824 patients undergoing 454 924 general anesthetics, 30 developed postoperative laryngeal injury (6.6/100 000; 95% CI 4.5-9.4) which did not resolve spontaneously and required laryngology evaluation. Of these 22 (67%) had well defined movement abnormalities: unilateral (n = 15) and bilateral vocal cord immobility (n = 1), unilateral hypomobility (n = 4), bilateral hypomobility (n = 1), combined unilateral vocal cord immobility with contralateral hypomobility (n = 1), and 11 (33%) had no movement abnormality. Twenty-one (64%) were intubated via video laryngoscopy. Follow-up was available for 21 patients (70%) with a median [IQR] duration of 12 [9-35] months; 15 (72%) showed partial improvement without complete resolution, while 6 showed no improvement.

Laryngeal injury following general anesthesia with tracheal intubation is a uncommon complication. In our series, approximately two-thirds of patients had identifiable injuries, while one-third exhibited no structural abnormality. While 75% of patients demonstrated partial symptomatic improvement, however, complete resolution was not observed in any of the patients who received follow-up in our institution, underscoring the severity of this complication.