Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery

Purpose

Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility.

Materials and methods

Retrospective case series at single tertiary referral center between 2002 and 2015. 141 patients were included who underwent laryngology interventions (micronized acellular dermis injection laryngoplasty and/or type 1 thyroplasty) to treat symptomatic UVFP diagnosed subsequent to cardiothoracic surgery.

Results

Pulmonary procedures were most often associated with UVFP (n = 50/141; 35.5%). 87.2% had left-sided paralysis (n = 123/141). Median time to diagnosis was 42 days ($\overline{x}$ = 114 ± 348). Over time, UVFP was diagnosed progressively earlier after cardiothoracic surgery. 63.4% of patients (n = 95/141) underwent injection laryngoplasty as their initial intervention with median time from diagnosis to injection of 11 days ($\overline{x}$ = 29.6 ± 54). 41.1% (n = 58/141) ultimately underwent type 1 thyroplasty at a median of 232.5 days ($\overline{x}$ = 367 ± 510.2) after cardiothoracic surgery. 10.2% (n = 9/88) of those with adequate follow-up recovered full vocal fold mobility.

Conclusions

Many cardiothoracic procedures are associated with symptomatic UVFP, predominantly left-sided. Our data showed poor recovery of vocal fold mobility relative to other studies. Early diagnosis and potential surgical medialization is important in the care of these patients.