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Diagnosis of recurrent laryngeal nerve paralysis following esophagectomy by evaluating movement of the vocal cords and arytenoid cartilages using ultrasonography

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Abstract

Advancements in thoracoscopic surgery have provided us with a deeper anatomical understanding of recurrent laryngeal nerve paralysis (RLNP), which is likely to occur after lymph node dissection. Taking a novel approach to researching the diagnosis of RLNP, we evaluated movement of the vocal cords and arytenoid cartilages using ultrasonography in patients who underwent thoracoscopic esophagectomy. RLNP occurred in six of the 24 patient cohort. The rate of hoarseness and difficulty in discharging sputum was significantly higher in the paralyzed group than in the non-paralyzed group. The diagnostic accuracy of RLNP by ultrasonography had a sensitivity of 83.3% (5/6), a specificity of 88.8% (16/18), a false positive rate of 5.6% (1/18), and a false negative rate of 0% (0/6). Although it is not completely accurate, our findings indicate that ultrasonography is quite effective for diagnosing RLNP, more so in combination with clinical symptoms. Ultrasonography may also be effective for identifying patients who are amenable to laryngoscopy for diagnosing RLNP, or for evaluating the recovery status of nerve paralysis.

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References

  1. Takeuchi H, Miyata H, Ozawa S, et al. Comparison of short- term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan. Ann Surg Oncol. 2017;24:1821–7.

    Article  Google Scholar 

  2. Koyanagi K, Kato F, Nakanishi K, Ozawa S. Lateral thermal spread and recurrent laryngeal nerve paralysis after minimally invasive esophagectomy in bipolar vessel sealing and ultrasonic energy devices: a comparative study. Esophagus. 2018;15:249–55.

    Article  Google Scholar 

  3. Paul BC, Rafii B, Achlatis S, et al. Morbidity and patient perception of flexible laryngoscopy. Ann Otol Rhinol Laryngol. 2012;121:708–13.

    Article  Google Scholar 

  4. Wong KP, Lang BHH, Lam S, et al. Determining the learning curve of transcutaneous laryngeal ultrasound in vocal cord assessment by CUSUM analysis of eight surgical residents: when to abandon laryngoscopy. World J Surg. 2016;40:659–64.

    Article  Google Scholar 

  5. Wong KP, Lang BH, Chang YK, et al. Assessing the validity of transcutaneous laryngeal ultrasonography (TLUSG) after thyroidectomy: what factors matter? Ann Surg Oncol. 2015;22:1774–80.

    Article  Google Scholar 

  6. Kandil E, Deniwar A, Noureldine SI, et al. Assessment of vocal fold function using transcutaneous laryngeal ultrasonography and flexible laryngoscopy. JAMA Otolaryngol Head Neck Surg. 2016;142:74–8.

    Article  Google Scholar 

  7. Kitagawa Y, Uno T, Oyama T, Kato K, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 2. Esophagus. 2019;16:25–43.

    Article  Google Scholar 

  8. Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14:1–36.

    Article  Google Scholar 

  9. Woo JW, Shu H, Song RY, et al. A novel lateral-approach laryngeal ultrasonography for vocal cord evaluation. Surgery. 2016;159:52–7.

    Article  Google Scholar 

  10. Borel F, Delemazure AS, Espitalier F, et al. Transcutaneous ultrasonography in early postoperative diagnosis of vocal cord palsy after total thyroidectomy. World J Surg. 2016;40:665–71.

    Article  Google Scholar 

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Correspondence to Shiro Fujihata.

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All procedures followed were in compliance with the ethical standards of the Responsible Commission on Human Experimentation (institutional and national) and the Helsinki Declaration of 1964 and later versions.

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Fujihata, S., Ogawa, R., Ito, S. et al. Diagnosis of recurrent laryngeal nerve paralysis following esophagectomy by evaluating movement of the vocal cords and arytenoid cartilages using ultrasonography. Esophagus 18, 704–709 (2021). https://doi.org/10.1007/s10388-021-00830-4

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  • DOI: https://doi.org/10.1007/s10388-021-00830-4

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