Early Unilateral Laryngeal Paralysis After Pulmonary Resection With Mediastinal Dissection for Cancer
Résumé
Objective : To document the symptoms, evolution, treatment decision and outcome in a large series of patients with unilateral laryngeal paralysis after mediastinal lymph node dissection and pulmonary resection for cancer. Methods : Retrospective series based on an inception cohort of 122 patients consecutively managed at a single institution. Treatement of the ULNP relied on isolated speech therapy in 38 patients and surgical medialisation of the paralysed vocal cord in 83 patients (37 intracordal injection of autologous fat and 46 type I thyroplasty with implant insertion). In one patient a total laryngectomy was performed. Duration of follow varied from 1-118 month. 94 patients had a minimum of 6 months of follow or were followed until either death or recovery of motion of the paralysed vocal cord occured. Results : Symptoms included swallowing impairment and dysphonia noted in 54.4 % and 99.2 % of patients, respectively. Recovery of motion of the paralysed vocal cord, noted in 25.9 % of patients referred before the sixth month after lung surgery, never occurred past this month and/or if the inferior laryngeal or Xth cranial nerves had been transected at time of lung surgery. In univariate analysis, a surgical medialisation of the paralysed vocal cord was statistically more likely to be performed in patients with swallowing impairment, severe dysphonia or paralysis of the left hemilarynx. When performed, medialisation of the paralysed larynx, resulted in an overall 96.3 % and 98,4 % improvement rate for dysphonia and swallowing impairment, repectively. Conclusions : Such results pledge for a close relationship between the thoracic and head and neck surgeon in patients with cancer amenable to lung resection with mediastinal lymph node dissection in an attempt to avoid the major complications related to aspiration and to improve the quality of life of this population.
Domaines
Linguistique
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