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Review
. 2017 Mar;8(1):54-63.
doi: 10.1177/2151458516681144. Epub 2016 Dec 27.

Indications for Direct Laryngoscopic Examination of Vocal Cord Function Prior to Anterior Cervical Surgery

Anirudh Gowd  1 , Alireza Nazemi  1 , Jonathan Carmouche  1 , Todd Albert  2 , Caleb Behrend  1
Affiliations
Review

Indications for Direct Laryngoscopic Examination of Vocal Cord Function Prior to Anterior Cervical Surgery

Anirudh Gowd et al. Geriatr Orthop Surg Rehabil. 2017 Mar.

Abstract

Recurrent laryngeal nerve palsy (RLNP) is among the most common complications in both thyroid surgeries and anterior approaches to the cervical spine, having both a diverse etiology and presentation. Most bilateral paresis, with subsequent devastating impact on patients, are due to failure to recognize unilateral recurrent laryngeal nerve paralysis and, although rare, are entirely preventable with appropriate history and screening. Recurrent laryngeal nerve palsy has been shown to present asymptomatically in as high as 32% of cases, which yields limitations on exclusively screening with physical examination. Based on the available literature, diagnosis of unilateral RLNP is the critical factor in preventing the occurrence of bilateral RLNP as the surgeon may elect to operate on the injured side to prevent bilateral paresis. Analysis of incidence rates shows postoperative development of unilateral RLNP is 13.1 (95% confidence interval [CI]: 6.1-28.1) and 13.90 (95% CI: 6.6-29.3) times more likely in anterior spine and thyroid surgery, respectively, in comparison with intubation. Currently, there is no consensus on when to order a preoperative laryngoscopic examination prior to anterior cervical spine surgery. The importance of patient history should be emphasized, as it is the basis for indications of preoperative laryngoscopy. Efforts to minimize postoperative complications must be made, especially when considering the rising rate of cervical fusion. This study presents a systematic review of the literature defining key causes of RLNP, with a probability-based protocol to indicate direct laryngoscopy prior to anterior cervical surgery as a screening tool in the prevention of bilateral RLNP.

Keywords: anterior cervical spine surgery; complications; direct laryngoscopy; etiology; incidence; recurrent laryngeal nerve palsy.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Etiology of unilateral recurrent laryngeal nerve palsy.
Figure 2.
Figure 2.
Etiology of bilateral recurrent laryngeal nerve palsy.
Figure 3.
Figure 3.
Recurrent laryngeal nerve anatomy in involvement with anterior approaches to the spine.
See this image and copyright information in PMC

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