Cases reported "Vocal Cord Paralysis"

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1/48. Paroxysmal laryngospasm after laryngeal nerve injury.

    OBJECTIVE: Describe a clinical syndrome of laryngeal hypersensitivity following laryngeal nerve injury. STUDY DESIGN: Retrospective review of six patients with laryngeal paralysis sustained during neck surgery who presented with paroxysms of coughing and stridor, progressing to brief episodes of complete airway occlusion. methods: Chart review. RESULTS: Superior laryngeal nerve blockade temporarily improved symptoms in four of five patients. Botulinum toxin relieved spasm in two of three patients and reduced symptoms in the third. Symptoms gradually diminished or resolved in four patients from 1 to 2.5 years later. One patient underwent arytenoidectomy and one patient has a tracheostomy. CONCLUSIONS: patients with laryngeal injury may present with stridor and acute airway obstruction secondary to paroxysmal laryngospasm. The authors have found that superior laryngeal nerve blockade or botulinum toxin may be effective in temporary relief of symptoms.
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2/48. A benign parathyroid cyst presenting with hoarse voice.

    Parathyroid tumours and cysts are rare and, when presenting as neck masses, can be clinically misdiagnosed as thyroid lesions. Symptoms may be caused by compression of the surrounding structures or hormonal overactivity. This paper describes a patient with recurrent hoarseness owing to the pressure effects of a parathyroid cyst on the recurrent laryngeal nerve.
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3/48. Immobile vocal fold secondary to thyroid abscess: a case report.

    Vocal fold paralysis as a result of a thyroid abscess is extremely rare. In this article, we report only the second documented case of such a finding. The paralysis was discovered after our patient, a 40-year-old woman, had come to the office with a complaint of discomfort in the right lower neck. Computed tomography confirmed the presence of an abscess in the posterior thyroid gland. Fine-needle aspiration did not identify any inflammatory or suspicious cells. The abscess was treated with hemithyroidectomy, and the paralysis resolved 3 weeks later. There has been no recurrence after 4 years.
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4/48. Combined use of endoscopic CO2 laser excision of a marginal laryngeal tumor, radical neck dissection, and perioperative laterofixation of the opposite vocal cord.

    We report the use of endoscopic laser excision of a marginal laryngeal tumor, radical neck dissection, and laterofixation of a paralyzed vocal cord in a 66-year-old man who had an early-stage right supraglottic endolaryngeal tumor and ipsilateral neck metastasis. He had a left vocal cord paralysis after a left pneumonectomy that was performed 5 years previously. The primary laryngeal tumor was excised by endoscopic CO2 laser resection, and a simultaneous radical neck dissection was carried out. Postoperatively, severe inspiratory dyspnea developed because of the surgical intervention on the right side causing moderate laryngeal edema and limited movement of the right vocal cord in addition to the paralyzed left side. An endolaryngeal laterofixation of the paralyzed left vocal cord was performed to provide the patient with an adequate airway instead of tracheostomy. This patient had a 2 years' follow-up without recurrence of tumor. In the meantime movement of the right vocal cord has returned, so that the patient's voice was socially acceptable and he has a functioning larynx.
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5/48. recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block.

    We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.
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6/48. Unusually aggressive rectal carcinoid metastasizing to larynx, pancreas, adrenal glands, and brain.

    Rectal carcinoids are slow-growing tumors. They metastasize when their size is more than 2 cm. Common sites of metastasis are the liver, lungs, and bones. Metastases to thyroid, pancreas, kidneys, adrenal glands, pituitary glands, posterior fossa, and spleen are very rare. We present the case of a 79-year-old white man with dysphagia and left vocal cord paralysis from a rapidly growing mass in his neck. Needle biopsy suggested thyroid anaplastic carcinoma, and the patient underwent total laryngectomy, total thyroidectomy, and left radical neck dissection. pathology showed undifferentiated carcinoid of the larynx. biopsy of a rectal mass suggested poorly differentiated carcinoma. Postoperatively the patient developed cardiac arrhythmias and died after 5 weeks. autopsy showed a 5-cm carcinoid of the rectum with extensive vascular invasion extending into the perirectal fat. There was metastatic disease to both lungs, liver, pancreas, both adrenal glands, peritoneum, subcutaneous tissues of thorax and abdomen, ribs, vertebrae, skull, and the leptomeninges of the cerebrum. Rectal carcinoids may present a variable histologic picture. Poorly differentiated tumors can present with widespread metastases and have poor prognosis. Extensive surgery may not improve the survival of patients with this pattern of unusually aggressive carcinoid.
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7/48. Thyroid hemangioma.

    A case is presented of a fifty-six year old man with a thyroid hemangioma presenting as a neck mass with tracheal deviation and unilateral vocal cord paralysis. A standard thyroid scan yielded equivocal findings. The diagnosis was determined preoperatively by the use of a 99m-technetium angiogram that disclosed the vascular nature of the lesion. Subsequent arteriography demonstrated the main arterial supply of the mass to be from both inferior thyroid arteries. Operative removal of the mass was accomplished through a standard transverse cervical incision. Pathologic study revealed that the vascular tumor involved both the surrounding normal thyroid parenchyma and also a microfollicular adenoma. This case points out the value of utilizing all available diagnostic means in atypical cases of thyroid disease.
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8/48. Clinical case seminar: Riedel's thyroiditis: report of a case complicated by spontaneous hypoparathyroidism, recurrent laryngeal nerve injury, and Horner's syndrome.

    A 42-yr-old woman presented with hyperthyroidism and a large, firm, irregular goiter. Within a few weeks she became hypothyroid. Five months later she developed increasingly severe neck pain and compressive symptoms. The goiter had become rock hard. A fine needle aspiration biopsy showed features of chronic thyroiditis and fibrosis. She partially responded to a course of glucocorticoids. tamoxifen was added, with marked improvement in goiter size and pain. Both medications were tapered off. Two months later the patient experienced paresthesias of the fingertips, perioral numbness, and a seizure. She was found to have spontaneous primary hypoparathyroidism. Three months later the patient became hoarse and experienced difficulty in breathing. She was found to have a massively enlarged thyroid with compression of the right internal jugular vein and encasement of the right carotid artery as well as tracheal narrowing. She also had right vocal cord paralysis due to recurrent laryngeal nerve involvement. Because of airway compromise, an emergency isthmusectomy was performed, and the patient was given a postoperative course of glucocorticoids with gradual improvement. Postoperative diagnosis was Riedel's thyroiditis. Two months later she presented with near-syncope and was found to have bradycardia, hypotension, and right Horner's syndrome, presumably due to compression of the right carotid sheath. She was given i.v. glucocorticoids and tamoxifen. Six months later and 18 months after her initial presentation, the patient is doing remarkably well. Her goiter has regressed by more than 50%, and she no longer has any pain or difficulty breathing. She remains a little hoarse and has persistent hypothyroidism and hypoparathyroidism. She is taking prednisone (5 mg, this is being tapered very slowly) and tamoxifen (20 mg) daily. This case illustrates the protean manifestations of Riedel's thyroiditis, a rare but fascinating disease. The epidemiology of this disease, its pathophysiology and complications, and the roles of surgery and medical therapy are reviewed.
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9/48. Vocal cord palsy resulting from spontaneous carotid dissection.

    OBJECTIVES/HYPOTHESIS: Vocal cord palsy has a variety of causes, such as malignant tumors of the thyroid, lung, or upper mediastinum, aortic aneurysm, surgery of the thyroid, and infectious diseases. STUDY DESIGN: Case report. methods: A 43-year-old biologist had a holocephalic headache and right-sided neck pain for 1 day. Five days later, he developed paralysis of the right-side vocal cord. In addition, an angiotensin converting enzyme (ACE) inhibitor was administered because the patient had high systolic and diastolic blood pressures, which were formerly not known to the patient. Five days after admission, a temporary sensorimotor hemiparesis occurred. RESULTS: Neurological examination revealed, in addition to the known paralysis of the right-side vocal cord, right-side palatoplegia, right-side hypoglossal nerve palsy, and mild dysphagia. Duplex sonography showed evidence of lumen narrowing of the right-side internal carotid artery caused by an hypoechogenic mural hematoma. magnetic resonance imaging (0.5 T, Philips Gyroscan) revealed a circumscribed dissection of the right-side internal carotid artery from the carotid bifurcation to the petrosal segment. The diffusion-weighted magnetic resonance imaging scan of the brain also demonstrated multiple embolic ischemic lesions in the right hemisphere. CONCLUSION: Internal carotid artery dissection must be included in the differential diagnosis of lower cranial nerve palsy and should be assessed by duplex ultrasonography and magnetic resonance imaging.
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10/48. Teflon-induced granuloma: a false-positive finding with PET resolved with combined PET and CT.

    patients who have undergone thyroidectomy may have recurrent laryngeal nerve injury; until recently, Teflon injection was commonly used for vocal cord medialization. We present a case of a patient who underwent thyroidectomy who had significantly increased and unilateral (18)F-fluorodeoxyglucose uptake in the neck, which was found to be localized to the left vocal cord by use of combined positron emission tomography (PET) and CT, presumably because of a Teflon-induced granuloma. knowledge of this potential source of false-positive PET interpretation because of its inability to precisely localize neoplastic lesions, and the use of combined PET and CT imaging, may allow precise diagnosis and prevention of unnecessary interventions.
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