The Laryngoscope · 1985 · 225 citations · 15 references
MedicineAnesthesiologyOtolaryngologyAnesthesiaLaryngologyNeurotologyAirway ObstructionEndotracheal IntubationLaryngeal TraumaNeurolaryngeal DisordersVocal Fold ParalysisArytenoid CartilagesEndotracheal Tube Cuff PressureIatrogenic Vocal Fold ParalysisLaryngeal ParalysisPeripheral Nerve TraumaPost-intubation Vocal Fold Paralysis
True vocal cord paralysis can result from peripheral nerve damage caused by compression between an inflated endotracheal tube cuff and the thyroid cartilage during intubation. The study aims to identify preventive methods to avoid this paralysis. Anatomical dissections pinpointed the injury site at the junction of the vocal process of the arytenoid cartilage and the membranous true vocal cord, 6–10 mm below the cord, and cuff pressures were monitored during anesthesia. Nitrous oxide diffuses into endotracheal tube cuffs, substantially raising intracuff pressure, and the resulting true vocal cord paralysis is usually temporary.
True vocal cord paralysis may follow endotracheal intubation and be the result of peripheral nerve damage. This damage can occur as the result of compressing the nerve between an inflated endotracheal tube cuff and the overlying thyroid cartilage. A series of anatomic dissections defined the likely site of injury to be at the junction of the vocal process of the arytenoid cartilage and the membranous true vocal cord approximately 6 to 10 mm below the level of the cord. Cuff pressures were monitored during anesthetics. Analysis of the results indicated that nitrous oxide diffuses into endotracheal tube cuffs causing a substantial increase in the intracuff pressure. We have concluded that true vocal cord paralysis which follows endotracheal intubation is usually temporary. The solution to the problem lies in its prevention and several methods are described whereby it may be avoided.
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