Bilateral vocal cord palsy after total thyroidectomy-A new treatment-Case reports

Fong-Fu Chou; Cheng-Ming Hsu; Chi-Chih Lai; Yi-Chia Chan; Shun-Yu Chi

doi:10.1016/j.ijscr.2017.06.045

Bilateral vocal cord palsy after total thyroidectomy-A new treatment-Case reports

Int J Surg Case Rep. 2017:38:32-36. doi: 10.1016/j.ijscr.2017.06.045. Epub 2017 Jun 30.

Authors

Fong-Fu Chou¹, Cheng-Ming Hsu², Chi-Chih Lai², Yi-Chia Chan¹, Shun-Yu Chi³

Affiliations

¹ Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung Taiwan 123,Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan.
² Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung Taiwan 123,Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan.
³ Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung Taiwan 123,Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan. Electronic address: choulu@cgmh.org.tw.

Abstract

Introduction: Dyspnea due to bilateral vocal cord palsy after total thyroidectomy (BVCPATT) is a life-threatening complication; nevertheless, we try to avoid tracheotomy.

Methods: Using normalized glottal area (NGA), we retrospectively studied 14 patients with BVCPATT. Nine patients without dyspnea were treated conservatively, while five with dyspnea received immediate bilevel positive air-way pressure (BiPAP) treatment. Both right and left recurrent nerves were grossly intact during surgery.

Results: The mean NGA during inspiration of five patients with dyspnea was less than that of nine patients without (6.21±1.57 (mean±standard deviation) vs. 20.5±9.5; p=0.001). The mean age of patients with dyspnea was more than that of patients without (61.6±15.6 vs. 38±10.2; p=0.007). Five patients with dyspnea that occurred at 0-8days post operation recovered within 3-17days after BiPAP.

Conclusion: Dyspnea occurred in patients with BVCPATT who were relatively older. The mean NGA during inspiration in patients with dyspnea was less than that in patients without. BiPAP might be a new treatment for dyspnea.

Keywords: Bilateral vocal cord palsy; Bilevel positive air-way pressure; Case report; Dyspnea; Normalized glottal area; Total thyroidectomy.