Hoping someone can give me some info - my father had open heart surgery a year ago July 4, 1996. He also had surgery on his left carotid artery, which I believe was blocked to the base of his brain. He came through the surgery fine, except he no longer has his regular voice. He sounds hoarse, has pressured speech at times, has trouble swallowing food, and his mouth appears to be drawn somewhat to the side when he smiles. He was also put through a stressful period from a few of the nurses while he was in intensive care (ICCU). I am wanting to know if his vagus nerve was damaged due to the carotid surgery? He was also intubated for over 6 hours, and I am wondering if this could have had any bearing on his vocal cord? He has been told that his one vocal cord is paralyzed. He had Teflon injected into but it did not bring his voice back to normal, in fact there is little improvement. Can you give me some information?
Reply: -------------------------
Vocal cord paresis or paralysis is a well-known potential complication of carotid endarterectomy surgery. This complication can occur due to injury to the vagus nerve that courses along the carotid artery. In many cases, vocal cord paresis following carotid artery surgery occurs because of simple pressure or retraction of the vagus nerve and is transient - full recovery can occur, but make take up to 12 months. With more serious injuries, vocal cord paralysis can be permanent. Vocal cord paralysis due to such vagal injuries is usually primarily associated with hoarseness, but can occasionally also cause difficulty swallowing. When vocal cord paralysis is considered permanent, vocal improvement can be achieved in many instances surgically. Teflon injection of the vocal cord has been a common method of improving the voice in vocal paralysis for many years. However, it has in the last few years been largely replaced by a newer procedure known as vocal cord medialization or thyroplasty. This procedure is performed under local anesthesia with some sedation and involves making a small neck incision over the cartilage of the voice box on the paralyzed side, creating a small window in the cartilage, and inserting an implant that has been custom designed for the individual patient through the cartilage window thereby repositioning the paralyzed vocal cord towards the midline. This thereby allows the normal vocal cord to come into contact with the paralyzed vocal cord with less effort and strain resulting in improved vocal amplitude as well as less vocal breathiness and fatigue. The procedure is done under local anesthesia so that the implant size can be fine tuned by listening to the patients voice when the implant is inserted. Teflon injections on the other hand involve injecting an inert non-absorbable substance directly into the muscle of the vocal cord thereby augmenting the size of the vocal cord to fill the gap to the midline created by the paralysis. The purported advantages of thyroplasty over Teflon injection is that the former procedure can be more precise and can restore a more natural vocal quality since it theoretically does not interfere with the natural vibratory characteristics of the vocal fold and muscle. I would suspect that there are still options available to your father for vocal improvement. Additional Teflon injection is a possibility but this would require careful assessment with laryngeal videostroboscopy to determine exactly why the initial Teflon injection was not successful - perhaps there is still a small gap present during vocalization which could be further augmented. However, Teflon injections are occasionally unsuccessful because there has been too much Teflon injected or the distribution of the Teflon has not resulted in a straight edge to the vocal cord. This can be very difficult to correct, but not necessarily impossible. I would suggest you consult with an ear, nose, and throat specialist with background in the contemporary advanced techniques of voice analysis and treatment.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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