Recurrent Laryngeal Nerve Palsy Following Blunt Trauma of Lateral Neck

Special Issue

Austin J Surg. 2014;1(5): 1021.

Recurrent Laryngeal Nerve Palsy Following Blunt Trauma of Lateral Neck

Tuzuner A1*, Demirci S1, Aydogan F1, Ceylan T2 and Karadas H1

1Department of Otolaryngology, Ankara Research and Training Hospital, Turkey

2Department of Otolaryngology, Diskapi Yildirim Beyazit Research and Training Hospital, Turkey

*Corresponding author: Tuzuner A, Department of Otolaryngology, Ministry of Health Ankara Training and Research Hospital, Cebeci, Ankara, Turkey

Received: July 29, 2014; Accepted: Aug 02, 2014; Published: Aug 06, 2014

Abstract

Objective: Laryngotracheal traumas are rare conditions and may cause wide spectrum of complications on the laryngeal airway. Impact of trauma may affect soft tissue, nerves and cartilage of larynx. For each injury, different treatment modalities from simple observation to urgent surgical intervention may be necessary.

Method: We would like to present a 24 year-old female patient who had a blunt trauma from lateral side of anterior neck that was resulted in hoarseness and breathiness of the voice in following days.

Results: On video-laryngostroboscopy, endolaryngeal soft tissue damage with restricted left vocal fold movement was observed. Partial recurrent laryngeal nerve damage showed on electromyography. Patient informed about the situation and injection laryngoplasty with hyaluronic acid was planned to be used to improve the voice quality during regeneration period.

Conclusion: Recurrent laryngeal nerve palsy due to blunt trauma is a very rare condition and laryngeal EMG is observed to be a very helpful tool for diagnosis and decision for treatment.

Keywords: Blunt neck trauma; Recurrent laryngeal nerve palsy; Laryngeal electromyography; Dysphonia

Introduction

Unilateral vocal fold paralysis (UVFP) causes breathiness, weakness of voice, swallowing problems due to restricted vocal fold motion which effects glottal closure. Most prominent causes of UVFP are idiopathic, iatrogenic injury (thyroidectomy, lung-mediastinum surgery, cervical spine esophageal, skull base, heart surgery etc.), radiation to the neck, oncologic diseases and blunt or sharp traumas to the neck region [1,2].

Blunt neck traumas involving larynx are very rare conditions and different type of injury to the laryngotracheal framework may result in from a simple soft tissue edema to life-threatening laryngotracheal separation. On clinical evaluation, patients may suffer from dyspnea, voice impairment, globus sensation or cough [3]. In the acute period of the injury airway evaluation is the priority for the patient. In the case of severe injury due to laryngeal collapse the emergent tracheotomy might be necessary. Complication rates are as high as 40% following neck traumas and blunt trauma seems to be less severe injury risk than sharp traumas [4,5]. Following trauma when acute period is overcome, the most presenting symptom is hoarseness that could be recurrent laryngeal nerve/superior laryngeal nerve paralysis, arytenoid subluxation or laryngeal cartilage fractures [6].

In the present report we would like to present a rare case that had isolated blunt trauma to the left side of her neck resulted in dysphonia and breathiness. After resolution of acute laryngeal findings, etiology is distinguished from two major causes of this condition.

Case Presentation

A twenty-four years old female who has dysphonia and globus sensation of throat following blunt injury to her left lateral side of anterior neck due to accidental car door crush. Patient applied our otolaryngology clinic two days ago. There was a mild soft tissue swelling anterior to the left sternocleidomastoid muscle with inspection and she had tenderness on the same region during palpation. The video-laryngostroboscopy showed endolaryngeal soft tissue swelling and ecchymosis on the left arytenoid mucosa, piriform sinus and restricted left vocal fold movement with 2 mm. opening between folds during phonation was observed (Picture 1). Considering edema and possible recurrent laryngeal nerve paralysis she was put on prednisolone treatment 1mg/kg for a week tapered by 20 mg per day and proton pomp inhibitor (30 mg lansoprazole daily). After one month follow-up, she still had similar symptoms and video-laryngostroboscopy (VLS) showed left vocal fold palsy with better closing defect less than 2 mm. glottal closures with phonation and scar tissue on the left piriform sinus mucosa (Picture 2). Laryngeal electromyography (EMG) planned to rule out arytenoid subluxation and design the proper treatment modality (Figure 1). Partial recurrent laryngeal nerve damage was observed showed on electromyography. Patient was informed about this temporary situation and injection laryngoplasty with hyaluronic acid was planned to improve the voice quality during regeneration period.