Other Procedures and Interventions

Endotracheal Intubation

Vocal fold paralysis occasionally follows surgery that does not place the nerve at risk. Such cases have been occasionally attributed to cricoarytenoid dislocation, but damage to this well-supported joint has been shown by anatomical study to be extremely unlikely [52,53], especially when no note was made of difficulty at intubation. Careful dissection has shown that the anterior branch of the recurrent laryngeal nerve is subject to compression between a "high-riding" endotracheal tube cuff and the thyroid cartilage, particularly if the cuff is over-inflated [54, 55]. Brief reflection on the number of intubations in comparison with the frequency of this cause of paralysis suggests that it is an extremely rare occurrence. No study has been made of its natural history, but as a neura-praxic injury, spontaneous resolution is probably the rule. As noted previously, it is entirely possible that many short-lived paralyses go undiagnosed, attributed to routine voice change following intubation.

Venous Access and Other Instrumentation

Individual cases of vocal fold paralysis have been reported to result from central venous catheterization via the internal jugular or the subclavian vein [56,57]. Such injuries of the recurrent nerve sometimes originate outside the medical setting among intravenous drug users [58, 59]. Vocal fold paralysis, distinct from cricoarytenoid dislocation, has been reported following nasogastric tube insertion [60, 61] and placement of an esophageal stethoscope [62]. It is attributed in these cases to local pressure palsies and local infection related to mucosal erosions.

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