Hamdan Abdel Latif, Moukarbel Roger V, Farhat Firas, Obeid Mounir
Department of Otolaryngology -- Head and Neck Surgery, American University of Beirut, Beirut, Lebanon.
Eur J Cardiothorac Surg. 2002 Apr;21(4):671-4. doi: 10.1016/s1010-7940(02)00019-2.
Vocal cord paralysis is a known entity often described as a complication of neck surgery. A less frequent site of injury to the recurrent laryngeal nerve is the chest. The left side is usually more affected than the right side in view of its long intrathoracic segment. Only few cases of right vocal cord paralysis following open-heart surgery are reported in the literature. The purpose of this article is to review the common possible mechanisms of injury to the right recurrent laryngeal nerve following open-heart surgery in order to draw the attention of the caring physician to the clinical significance of such a complication. In fact, transient hoarseness following open-heart surgery may be an ominous sign of recurrent laryngeal nerve injury. It should not be assumed to be secondary to intralaryngeal edema. Several mechanisms of injury to the recurrent laryngeal nerve have been suggested: (1) through central venous catheterization; (2) by traction on the esophagus; (3) by direct vocal cord damage or palsy from a traumatic endotracheal intubation; (4) trauma by compression of the recurrent laryngeal nerve or its anterior branch at the tracheoesophageal groove by an inappropriately sized endotracheal tube cuff; (5) by a faulty insertion of a nasogastric tube; (6) median sternotomy and/or sternal traction pulling laterally on both subclavian arteries; (7) direct manipulation and retraction of the heart during open-heart procedures; (8) hypothermic injury with ice/slush. If vocal cord paralysis was overlooked as a possible complication of open-heart surgery, the patient may suffer from dysphonia in addition to problems of paramount importance such as inefficient cough and aspiration. Although it is true that the incidence of vocal cord paralysis remains very low, yet its presence is alarming and necessitates close follow up on the patient for the possible need of surgical intervention if recovery fails.
声带麻痹是一种已知的疾病，常被描述为颈部手术的并发症。喉返神经较少见的损伤部位是胸部。鉴于其较长的胸内段，左侧通常比右侧受影响更严重。文献中仅报道了少数心脏直视手术后右侧声带麻痹的病例。本文的目的是回顾心脏直视手术后右侧喉返神经损伤的常见可能机制，以引起临床医生对这种并发症临床意义的关注。事实上，心脏直视手术后短暂的声音嘶哑可能是喉返神经损伤的不祥征兆。不应将其假定为继发于喉内水肿。已提出几种喉返神经损伤的机制：（1）通过中心静脉置管；（2）食管受牵拉；（3）因创伤性气管插管导致声带直接损伤或麻痹；（4）尺寸不合适的气管导管套囊在气管食管沟处压迫喉返神经或其前支造成创伤；（5）鼻胃管插入不当；（6）正中胸骨切开术和/或胸骨牵拉使双侧锁骨下动脉向外侧移位；（7）心脏直视手术过程中对心脏的直接操作和牵拉；（8）冰/冰泥造成的低温损伤。如果将声带麻痹作为心脏直视手术可能的并发症而被忽视，患者除了会出现诸如咳嗽无力和误吸等至关重要的问题外，还可能患有发音障碍。尽管声带麻痹的发生率确实仍然很低，但其存在令人担忧，有必要对患者进行密切随访，以便在恢复失败时可能需要进行手术干预。
