Clinical Findings and Treatment Approach for Unilateral Recurrent Laryngeal Nerve Palsy with Ankylosis in Fixation of the Cricoarytenoid Joint

Abstract

We report three cases of severe voice disorder induced by unilateral recurrent nerve palsy with ankylosis of the cricoarytenoid joint on the affected side. The voice quality of the patients was severe breathiness voice approaching aphonia. In all patients, the left recurrent nerve palsy occurred after an operation for aortic arch aneurysm displacement. (Patients 1 and 3 underwent dissection of the left recurrent nerve during surgery, and patient 2's pathological findings revealed neurogenic atropic change of the posterior cricoarytenoid muscle on the affected side.) During the operations for aortic arch displacement, transesophageal echocardiographies were performed to monitor the cardiovascular condition of all patients. These showed findings similar to laryngeal fiberscopic, CT and intraoperative findings. Laryngeal fiberscopic findings revealed that during inspiration the left vocal fold was fixed at an excessively lateral position higher than the right vocal fold, and vocal recess of the arytenoid cartilage on the left side could not be well detected. During phonation, severe glottal closure incompetence could be seen. CT findings showed the arytenoid cartilage atop and adhering to the posterior edge of the cricoid cartilage. During palpation of the left arytenoid cartilage, fixation of the cricoarytenoid joint could be detected. After stripping the posterior cricoarytenoid muscle on the left side posteriorly, it could be seen that the surface of the cricoarytenoid joint of the arytenoid cartilage was fixed crossing over the posterior edge of the cricoid cartilage posteriorly. We performed release of the fixation of the cricoarytenoid joint, and the pulled to rotate the muscular process of the arytenoid cartilage on the left side. The patients' voices improved.