Potesta Mark A, Shibani Akram
Medical School, Lake Erie College of Osteopathic Medicine, Bradenton, USA.
Pulmonary and Critical Care, Ascension St. Vincent Hospital, Jacksonville, USA.
Cureus. 2024 Sep 6;16(9):e68798. doi: 10.7759/cureus.68798. eCollection 2024 Sep.
Bilateral vocal cord paralysis poses life-threatening risks to patients who do not undergo prompt diagnostic intervention and airway management. Although developing bilateral vocal cord paralysis is extremely rare, if injury does occur, it is more frequently due to surgical resection sequelae in the neck. This case is particularly unique as we present a patient with a history of stage III laryngeal carcinoma status post chemotherapy in remission, who developed respiratory distress three days following an upper endoscopy procedure for an esophageal stricture at the level of the cricopharyngeus muscle, where he received a botulinum injection. This manuscript discusses the anatomy, clinical practices of botulinum toxin, nerve innervation, and mechanisms of injury for patients who develop bilateral recurrent laryngeal nerve injury. In addition, this manuscript details vocal cord positioning and how the positioning of the cords during laryngoscopy investigation can lead to diagnostic confirmation. With few reported cases of bilateral recurrent laryngeal nerve injury secondary to botulinum toxin particularly at the cricopharyngeus level, this report should serve as a guide for future clinicians regarding the risks of using this toxin, the risks of local spread, and management.
双侧声带麻痹会给未及时接受诊断性干预和气道管理的患者带来危及生命的风险。虽然双侧声带麻痹的发生极为罕见，但如果确实发生损伤，更常见的原因是颈部手术切除的后遗症。本病例尤为独特，我们报告了一名曾患III期喉癌且化疗后处于缓解期的患者，在进行环咽肌水平食管狭窄的上消化道内镜检查并接受肉毒杆菌注射三天后出现呼吸窘迫。本文讨论了双侧喉返神经损伤患者的解剖结构、肉毒杆菌毒素的临床应用、神经支配及损伤机制。此外，本文详细介绍了声带定位以及喉镜检查时声带的定位如何有助于确诊。由于肉毒杆菌毒素继发双侧喉返神经损伤的报道病例很少，尤其是在环咽肌水平，本报告应为未来临床医生提供有关使用该毒素的风险、局部扩散风险及管理的指导。
