PEDIATRICS Vol. 87 No. 1 January 1991, pp. 39-43
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Stridor: Intracranial Pathology Causing Postextubation Vocal Cord Paralysis

Frank C. Chaten MD1, Steven E. Lucking MD1, Edwin S. Young MD1, and John J. Mickell MD1

1 From the Division of Pediatric Critical Care Medicine, Children's Medical Center, Medical College of Virginia, Richmond

During an 18-month period in a pediatric intensive care unit, nine patients with vocal cord paralysis were identified using flexible bronchoscopy. When tracheally extubated, each child was found to have stridor. The children ranged in age from 17 days to 5frac12 years. Two patients had unilateral paralysis, but neither required tracheostomy. Seven patients displayed bilateral abductor vocal cord paralysis. Of these, six patients required tracheostomy. Surgical injury to the recurrent laryngeal nerve was the probable cause in two patients. The other seven patients had neurologic disorders with documented or suspected increases of intracranial pressure. Four of the seven patients with bilateral abductor vocal cord paralysis regained cord mobility within 4 months. Both children with unilateral cord paralysis have no stridor and vocalize well 1 year later. Cord paralysis in the setting of intracranial hypertension probably results from compression or ischemia of the vagus nerve before it exits the skull. Early visualization of the larynx should be done in patients who become stridulous when extubated, especially those with prior thoracic procedures or with neurologic disorders associated with intracranial hypertension.

Key Words: vocal cord paralysis • increased intracranial pressure

Submitted on January 16, 1990
Accepted on February 28, 1990




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