Evman Melis Demirag, Selcuk Ayse Adin
Department of Otorhinolaryngology-Head and Neck Surgery, Dr. Lutfi Kirdar Training and Research Hospital.
Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Bahcesehir University, Istanbul, Turkey.
J Craniofac Surg. 2020 Mar/Apr;31(2):e119-e120. doi: 10.1097/SCS.0000000000005959.
Endotracheal intubation is a commonly used method for securing airway. It is considered to be safe but it can still lead to some complications of the airway. Recurrent nerve paralysis due to endotracheal intubation is a rare complication. Pathophysiology is explained as neuropraxia of RLN's compression between the tube and the lamina of the thyroid cartilage or between arytenoid and cricoid cartilages due to tube cuff pressure or tube itself. In literature, unilateral vocal cord paralysis (VCP) due to intubation is more common than bilateral paralysis. In the presented case report, a young patient stayed intubated for only 3 days in intensive care unit who experienced bilateral VCP 2 days after extubation. He had total recovery 5 days after emergency tracheotomy suggesting neuropraxia of the nerve. Neuropraxia of RLN resulting in bilateral VCP due to inappropriate size or excess cuff pressure of the intubation tube may be the underlying reasons. The clinicians must be aware of complications of intubation and should apply appropriate treatment method as soon as possible. Appropriate size and cuff pressure should be chosen for endotracheal intubation.
气管插管是确保气道安全的常用方法。它被认为是安全的，但仍可能导致一些气道并发症。气管插管引起的喉返神经麻痹是一种罕见的并发症。其病理生理学解释为，由于气管导管套囊压力或导管本身，喉返神经在导管与甲状软骨板之间或杓状软骨与环状软骨之间受到压迫而发生神经失用。在文献中，插管引起的单侧声带麻痹比双侧麻痹更常见。在本病例报告中，一名年轻患者在重症监护病房仅插管3天，拔管后2天出现双侧声带麻痹。紧急气管切开术后5天他完全康复，提示神经失用。插管导管尺寸不当或套囊压力过大导致喉返神经失用，进而引起双侧声带麻痹可能是根本原因。临床医生必须意识到插管的并发症，并应尽快应用适当的治疗方法。气管插管时应选择合适的尺寸和套囊压力。
