From the Guidelines
Bilateral recurrent laryngeal nerve injury typically presents with symptoms ranging from stridor and acute airway obstruction to serious effects on patient social interaction and occupational status. According to the study by C. Gambardella et al. 1, symptoms of bilateral recurrent laryngeal nerve injury can be severe and include stridor, acute airway obstruction, and significant impacts on the patient's quality of life.
Key Symptoms
- Stridor and acute airway obstruction
- Serious effects on patient social interaction and occupational status
- Potential for catastrophic complications due to paralysis of the abductor muscle of the vocal cords, the posterior cricoarytenoid muscle
Clinical Implications
The study highlights the importance of recognizing and managing bilateral recurrent laryngeal nerve injuries promptly, as they can have serious consequences for the patient's morbidity, mortality, and quality of life 1. The symptoms and potential complications of bilateral recurrent laryngeal nerve injury necessitate urgent medical attention and intervention, such as tracheostomy, to secure the airway and prevent further complications.
Management and Prevention
While the study discusses the importance of capsular dissection, visual identification, and intraoperative nerve monitoring in reducing the risk of recurrent laryngeal nerve injuries 1, it is crucial to prioritize the patient's outcome in terms of morbidity, mortality, and quality of life when managing these injuries. This may involve a multidisciplinary approach, including surgical intervention, speech therapy, and other supportive measures to mitigate the effects of the injury and optimize the patient's recovery and quality of life.
From the Research
Symptoms of Bilateral Recurrent Laryngeal Nerve Injury
- Massive stridor on inspiration is a key symptom of bilateral recurrent laryngeal nerve injury, as noted in the study 2.
- Respiratory distress is a common symptom, which can be life-threatening if not promptly addressed 3, 4, 5.
- Hoarseness and dysphagia may also occur, as seen in a case of bilateral recurrent laryngeal nerve paralysis following COVID-19 treatment 6.
- Vocal cord paralysis can lead to upper airway obstruction, which may require emergency intervention, including tracheostomy 3, 4, 5, 6.
Clinical Presentation
- The symptoms of bilateral recurrent laryngeal nerve injury can develop suddenly and unexpectedly, even in the absence of obvious intraoperative nerve injury 3.
- The condition can be caused by various factors, including iatrogenic lesions, thyroid surgery, and botulinum toxin injection 2, 5.
- The clinical presentation may vary depending on the underlying cause and the severity of the injury 2, 3, 4, 5, 6.