Abstract | November 18, 2023
Vocal Fold Paralysis Following Blunt Trauma: A Case Study
Learning Objectives
- Upon completion of this lecture, learners should be better prepared to recognize vocal cord paralysis as a possible complication of blunt force trauma.
Introduction
Vocal fold paralysis is typically secondary to a myriad of causes, including sharp trauma or iatrogenically during neck surgery. It is very seldom due to blunt trauma to the neck. When it does happen, the airway can be compromised due to paramedian vocal cords and mitigating measures such as tracheostomy must be performed.
Case Presentation
This is a 31-year-old male sustaining blunt trauma to the neck after falling off a bicycle onto a ball hitch with his neck. Physical exam was notable for crepitus to the neck. He decompensated shortly after arrival and was intubated secondary to stridor. Computed tomography revealed two areas of tracheal rupture inferior to the vocal cords, a right pneumothorax, and pneumomediastinum. He was taken to the OR where a defect in the cricothyroid membrane was discovered and repaired. He remained intubated for three days, with a planned, extubated direct laryngoscopy performed by ENT. Upon extubation, he developed inspiratory stridor refractory to racemic epinephrine and Decadron. A bedside flexible scope revealed paramedian and paretic vocal cords indicating bilateral vocal cord paralysis.
Management/Outcome/Follow-up
He underwent an urgent tracheostomy to secure his airway while allowing his vocal cords to recover. Three days later a flexible laryngoscopy showed the left cord moving almost completely normally while the right cord was hypomobile. The patient’s tracheostomy was capped and a speaking valve was placed. The patient was discharged two days later with a plan to decannulate in clinic. Bronchoscopy one day following admission showed the left vocal fold to be hypokinetic and not well coapting while the right fold was midline. Two days later the vocal folds were approximating midline bilaterally with a slight posterior gap. Additionally, there was complete adduction with cued phonation and breath hold, and functional vocal fold abduction at rest. The tracheostomy was downsized the following day and the patient was discharged a day later. At follow-up, a flexible laryngoscope revealed both vocal cords moving well bilaterally.
References and Resources
- Wang H-W, Lu C, Lee F-P, Chao P-Z. Causes of vocal fold paralysis – sage journals. Sage Journals. October 22, 2020. Accessed July 6, 2023. https://journals.sagepub.com/doi/10.1177/0145561320965212.
