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Recurrent laryngeal nerve dysfunction following carotid endarterectomy
A J Curran1, D Smyth, S J Sheehan
1Royal College of Surgeons in Ireland, Professorial Department of Otolaryngology, Dublin, Ireland.
Journal of the Royal College of Surgeons of Edinburgh
|June 1, 1997
Summary
Carotid endarterectomy can cause temporary vocal cord issues, with permanent paralysis rare. Pre-operative vocal cord assessment is crucial for patients undergoing this surgery.
Area of Science:
- Neurology
- Otolaryngology
- Vascular Surgery
Background:
- Recurrent laryngeal nerve dysfunction and vocal cord paralysis are significant morbidities following carotid endarterectomy.
- Understanding the frequency and nature of vocal cord damage is crucial for patient outcomes.
Purpose of the Study:
- To prospectively assess vocal cord damage after carotid endarterectomy.
- To determine the frequency and characteristics of recurrent laryngeal nerve dysfunction.
- To identify potentially avoidable factors contributing to vocal cord damage.
Main Methods:
- Prospective study of 50 consecutive patients undergoing carotid endarterectomy.
- Standardized surgical technique emphasizing vagus nerve identification and minimal tissue disturbance.
- Pre-operative and post-operative (day 2) indirect laryngoscopy and videostroboscopy.
Main Results:
- One patient had pre-existing asymptomatic vocal cord paralysis.
- 3% of patients had asymptomatic impaired vocal cord mobility post-operatively, with full recovery.
- 12% experienced post-operative hoarseness, with 5% fully recovering.
- 2% developed permanent vocal cord paralysis.
Conclusions:
- Recurrent laryngeal nerve dysfunction is a common, often transient, complication of carotid endarterectomy.
- A minimal dissection technique may reduce the incidence of vocal cord paralysis.
- Pre-operative vocal cord assessment is essential for all patients undergoing carotid endarterectomy.