Tüzüner A, Demirci Ş, Aydoğan F, Ceylan T, Karadaş H

Künt Lateral Boyun Travma Sonrası Oluşan Rekürren Sinir Paralizisi : Olgu Sunumu

Laringotrakeal travmalar nadir görülen yaralanmalar olup laryngeal havayolunda geniş bir spektrumu içeren komplikasyon serisine yol açabilirler. Travmanın şiddetine göre larinks yumuşak dokusu, sinirleri ve kartilajları değişen oranlarda etkilenebilir.Yaralanma düzeyine göre basit gözlemden acil cerrahi müdahaleye kadar farklı tedavi modaliteleriyle müdahaleyi gerektirebilir.Bu olgu sunumunda boynun sol antero-lateral kısmına aldığı künt travmayı takiben ses kısıklığı ve nefes darlığı tarifleyen 24 yaşında bayan hastada tespit edilen sol rekürren laringeal sinir hasarı tartışılmıştır.Hastanın yapılan laringostroboskobik muayenesinde endolaringeal yumuşak doku hasarı ve sol vokal kord hareketlerinde kısıtlılık izlenmiştir.Yapılan elektromiyografisi parsiyel sol rekürren laringeal sinir paralizisi ile uyumlu bulunmuştur. Hastaya rejenerasyon sürecinde, ses kalitesinde düzelme sağlamak amaçlı hyaluronik asit enjeksiyonu yapılmıştır. Künt travmaya bağlı rekürren laryngeal sinir hasarı son derece nadir görülmekte olup laryngeal elektromiyografi tanı ve tedavinin planlanmasında etkin bir araçtır

Anahtar Kelimeler:

Boyun yaralanması, rekürren laryngeal sinir paralizisi, elektromiyografi, disfoni

Recurrent Laryngeal Nerve Palsy Following Blunt Trauma Of Lateral Neck: Case Report

Laryngotracheal traumas are rare conditions and may cause wide spectrum of complications on the laryngeal airway. According the severity of the trauma laryngeal soft tissue, nerves and cartilage may be affected in varying proportions. Due to the severity of the injury, different treatment modalities from simple observation to urgent surgical intervention may be necessary.In this case report a 24 year-old female patient who had a blunt trauma from left lateral side of anterior neck that resulted in hoarseness and breathiness of the voice with detected left recurrent laryngeal nerve injury is presented.On videolaryngostroboscopy examination, endolaryngeal soft tissue damage with restricted left vocal fold movement was observed. Partial recurrent larygeal nerve damage showed on electromyography. Injection laryngoplasty with hyaluronic acid was planned to be used to improve the voice quality during regeneration period. Recurrent laryngeal nerve palsy due to blunt trauma is a very rare condition and laryngeal electromyography is an effective tool for diagnosis and for planning the treatment

Keywords:

Neck injuries, recurrent laryngeal nerve palsy, electromyography, dysphonia,

___

Fang TJ, Fang TJ, Pei YC, Li HY, Wong AM, Chiang HC. Glottal gap as an early predictor for permanent laryngoplasty in unilateral vocal fold paralysis. Laryngoscope. 2014;124(9):2125-30
Alghonaim Y, Roskies M, Kost K, Young J.Evaluating the timing of injection laryngoplasty for vocal fold paralysis in an attempt to avoid future type 1 thyroplasty.J Otolaryngol Head Neck Surg. 2013; 19;42:24.
Wu MH, Tsai YF, Lin MY, Hsu IL, Fong Y.Complete laryn- gotracheal disruption caused by blunt injury. Ann Thorac Surg. 2004;77(4):1211-5.
Gussack GS, Jurkovich GJ, Luterman A.Laryngotracheal trauma: a protocol approach to a rare injury. Laryngoscope. 1986;96(6):660-5.
Schaefer SD.The acute management of external laryngeal trau- ma. A 27-year experience. Arch Otolaryngol Head Neck Surg. 1992;118(6):598-604.
Sulica L. The natural history of idiopathic unilateral vocal fold pa- ralysis: evidence and problems. Laryngoscope. 2008;118(7):1303-7.
Munin MC, Rosen CA, Zullo T. Utility of laryngeal electromyo- graphy in predicting recovery after vocal fold paralysis.Arch Phys Med Rehabil. 2003;84(8):1150-3.
Young VN, Smith LJ, Rosen C.Ann Otol Rhinol Laryngol. 2013;122(3):197-204.Voice outcome following acute unilateral vocal fold paralysis.
Joo D, Duarte VM, Ghadiali MT, Chhetri DK.Recovery of vo- cal fold paralysis after cardiovascular surgery.Laryngoscope. 2009;119(7):1435-8.
Schroeder U, Motzko M, Wittekindt C, Eckel HE. Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review.Eur Arch Otorhinolaryngol. 2003;260(6):304-7.
Kumral TL, Yıldırım G, Uyar Y, Kuzdere M, Yurtseven C, Güm- rükçü S, Öztürkçü Y. Travmatik vokal kord paralizisi Turk Arch Otolaryngol 2011; 49: 74-77.