Abstract
A comparative study was conducted on hoarseness and swallowing difficulties based mainly on pre- and postoperative findings of the vocal cords of 32 patients who had undergone operations for esophageal cancer at Jikei University School of Medicine between January 2002 and June 2003. Evaluation on the 5th postoperative day showed vocal cord paralysis in 27 of the 32 cases. Among them, 20 cases were unilateral and 7 bilateral. Eleven of the 20 patients with unilateral vocal cord paralysis recovered spontaneously by 3 months after surgery. Five patients with persistent vocal cord paralysis, who desired improvement in their hoarseness and swallowing difficulties, underwent intracordal atelocollagen injection. Severe breathy hoarseness and swallowing difficulties due to fixation at the paramedian position persisted in 2 patients with bilateral vocal cord paralysis, but their situations improved by 3 months postoperatively. On postoperative day 12, electromyography was performed on 24 thyro-arytenoid muscles in 17 patients. Among them, the patients whose electromyogram showed an “n” discharging pattern recovered spontaneously within 3 months after surgery.
These findings suggest that appropriate decisions on when to start oral intake after surgery can be made on the basis of assessment and diagnosis of sensory of larynx and vocal cord paralysis and electromyography, with otolaryngologists playing a major part. These procedures also enable earlier recovery of general condition with thoracoscopic surgery and shorter hospital stays.
