Concomitant type I thyroplasty and thoracic operations for lung cancer: Preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury

Objectives: We sought to prevent postoperative swallowing disorder, aspirat ion, and sputum retention in cases of recurrent laryngeal or vagus nerve se ction occuring during lung cancer resection. Methods: In 14 of 15 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patient s had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anest hesia (ie, without intraoperative phonatory control). Nine remaining patien ts had a type I thyroplasty delayed from thoracic operations because of int raoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative e records consisted of swallowing a bility, respiratory complications, and quality of voice. Results: No swallowing disorder, aspiration, or sputum retention occurred i n cases of concomitant laryngeal and thoracic operations. Of these 14 patie nts, a single case (7%) of major complication (vocal fold overmedialization ) occurred and required an early and successful revision thyroplasty; one c ase of cervical hematoma that did not require surgical drainage was conside red a minor complication (7%). Twelve (86%) patients who underwent the conc omitant association of both operations were fully satisfied with their qual ity of voice. Conclusions: Type T thyroplasty and thoracic operation can be advantageousl y associated in case of injury to laryngeal motor innervation to prevent po stoperative swallowing disability and dramatic respiratory complications.