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J Thorac Cardiovasc Surg 2001;121:642-648
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery

Concomitant type I thyroplasty and thoracic operations for lung cancer: Preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury

From the Departments of Otolaryngology and Head and Neck Surgery,^a General and Thoracic Surgery,^b Anesthesia,^c and Radiology,^d University Hospital Center, University of Auvergne, Clermont-Ferrand, France.

Received for publication July 12, 2000. Revisions requested Aug 29, 2000; revisions received Sept 14, 2000. Accepted for publication Oct 25, 2000. Address for reprints: Thierry Mom, MD, PhD, Service d'ORL et de Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire, 30 place Henri Dunant, 63 000 Clermont-Ferrand, France (E-mail: tmom{at}chu-clermontferrand.fr).

Abstract

Objectives: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occuring during lung cancer resection.
Methods: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice.
Results: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice.
Conclusions: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.

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