Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Hammer, GP; Tomazic, PV; Vasicek, S; Graupp, M; Gugatschka, M; Baumann, A; Konstantiniuk, P; Koter, SH.
Carotid endarterectomy significantly improves postoperative laryngeal sensitivity.
J Vasc Surg. 2016; 64(5):1303-1310 Doi: 10.1016/j.jvs.2016.04.032 [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz: Hammer Georg
Co-Autor*innen der Med Uni Graz: Baumann Anneliese; Gugatschka Markus; Koiner-Graupp Matthias; Konstantiniuk Peter; Koter Stephan Herwig; Tomazic Peter Valentin; Vasicek Sarah Marvis
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Abstract:: Iatrogenic injury of the vagus nerve or its branches during carotid endarterectomy (CEA) can result in globus sensation, dysphagia, and even vocal fold immobility. Knowledge of morphologic and functional laryngopharyngeal outcomes after CEA is poor. The present study was performed to determine potential iatrogenic damage to the laryngeal innervation after CEA. An area of particular interest was the supraglottic sensory threshold, which was examined by Fiberoptic Endoscopic Evaluation of Swallowing With Sensory Testing (FEESST; Pentax Medical Company, Montvale, NJ), a validated and safe method for the determination of the motor and sensory components of swallowing. FEESST was used preoperatively in 32 patients scheduled to undergo CEA and twice postoperatively to examine the motor and sensory components of swallowing. In this endolaryngeal examination, laryngopharyngeal sensory thresholds (in mm Hg) were defined as normal at <4.0 mm Hg air pulse pressure (APP), moderate deficit at 4.0 to 6.0 mm Hg APP, or severe deficit at >6.0 mm Hg APP, with a value >10.0 mm Hg APP indicating abolished laryngeal adductor reflex. Acoustic voice parameters were also analyzed for further functional changes of the larynx. The mean ± standard deviation preoperative FEESST measures showed no significant differences (P = .065) between the operated-on side (6.73 ± 1.73 mm Hg) and the opposite side (5.83 ± 1.68 mm Hg). At 2 days postoperatively, the threshold increased (P = .001) to 7.62 ± 1.98 mm Hg on the operated-on side. A laryngopharyngeal mucosal hematoma on the operated side was endoscopically detectable in eight patients (30.8%); in these patients, we found a markedly elevated (P = .021) measure of 9.50 ± 0.93 mm Hg. On the opposite (nonoperated-on) side of the laryngopharynx, the thresholds remained at the same level as preoperatively over all assessments (P >.05), whereas the differences between the operated and nonoperated-on sides and the hematoma and nonhematoma groups were highly significant (P = .004 and P = .001, respectively). Surprisingly, the sensory threshold on the operated-on side (6.08 ± 2.02 mm Hg) decreased significantly at the 6-week follow-up, even in relation to the preoperative measure (P = .022). With the exception of one patient with permanent unilateral vocal fold immobility, no signs of nerve injury were detected. In accordance with previous reports, injuries to the recurrent laryngeal nerve during CEA seem to be rare. In most patients, postoperative symptoms (globus, dysphagia, dysphonia) and signs fade within a few weeks without any specific therapeutic intervention. This study shows an improved long-term postoperative superior laryngeal nerve function with regard to laryngopharyngeal sensitivity. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing): Acoustics -; Aged -; Aged, 80 and over -; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - physiopathology; Carotid Artery Diseases - surgery; Deglutition -; Deglutition Disorders - etiology; Deglutition Disorders - physiopathology; Dysphonia - etiology; Dysphonia - physiopathology; Endarterectomy, Carotid - adverse effects; Esophagoscopy -; Female -; Fiber Optic Technology -; Humans -; Iatrogenic Disease -; Laryngeal Nerve Injuries - etiology; Laryngeal Nerve Injuries - physiopathology; Laryngeal Nerves - physiopathology; Larynx - physiopathology; Male -; Middle Aged -; Motor Activity -; Predictive Value of Tests -; Pressure -; Prospective Studies -; Recovery of Function -; Sensory Thresholds -; Speech Production Measurement -; Time Factors -; Treatment Outcome -; Voice Quality -