HSC Section 6 Nov2016 Green Book

Spataro et al

Table 4. Percentage of Patients Presenting to Washington University School of Medicine within 2, 3, and 4 Months from Symptom Onset. a

No. (%)

Etiology

n

Within 2 Months

Within 3 Months

Within 4 Months

Intracranial surgery Skull base surgery

24 18 22 48 61 18 73 17 58 37 18 20 14 73 11 24 58 30 18

17 (70.8) 15 (83.3) 10 (45.5) 23 (47.9) 33 (54.1) 13 (72.2) 81 (57.9) 51 (69.9) 12 (70.6) 19 (32.8) 29 (78.4) 10 (55.6) 11 (55.0) 6 (42.9) 46 (63.0) 9 (81.8) 17 (70.8) 48 (38.7) 40 (69.0) 14 (46.7) 7 (38.9)

17 (70.8) 15 (83.3) 13 (59.1) 26 (54.2) 36 (59.0) 13 (72.2) 86 (61.4) 57 (78.1) 12 (70.6) 41 (70.7) 31 (83.8) 10 (55.6) 13 (65.0) 6 (42.9) 54 (74.0) 10 (90.9) 19 (79.2) 64 (51.6) 46 (79.3) 18 (60.0) 9 (50.0)

17 (70.8) 16 (88.9) 13 (59.1) 31 (64.6) 40 (65.6) 13 (72.2) 93 (66.4) 62 (84.9) 13 (76.5) 44 (75.9) 32 (86.5) 12 (66.7) 13 (65.0) 8 (57.1) 60 (82.2) 10 (90.9) 19 (79.2) 68 (54.8) 50 (86.2) 19 (63.3) 10 (55.6)

Carotid surgery

Cervical spine surgery Lateral neck surgery Parathyroid surgery

Thyroid surgery

140

Lung surgery

Mediastinal surgery

Cardiac surgery

Esophageal surgery Skull base tumor Laryngeal cancer

Thyroid cancer—direct invasion

Lung cancer

Esophageal cancer Metastatic cancer

Idiopathic Intubation

124

Trauma

CVA

Abbreviation: CVA, cerebral vascular accident. a Etiologies with less than 10 patients not shown.

Table 5. Some Comparisons between the 3 Largest Series of Unilateral Vocal Fold Paralysis Etiologies. a

Rosenthal et al 15 (n = 643)

Takano et al 16 (n = 797)

Etiology

Present Study (n = 938)

Surgery, total

36.5 12.4 24.1

51.1 14.1 37.1

55.6 16.8 38.8 17.8 13.2 66.2 6.2

Thyroid/parathyroid

Nonthyroid

Intubation Malignancy Idiopathic

5.8

7.3 9.9

18.4 18.5

16.8 64.0

60.9 b

Left side

a All values are percentages. b Data reported for only 56.4% of patients in study.

have actually been cricoarytenoid joint ankylosis or dislocation that was misdiagnosed as UVFP. Idiopathic . This is commonly presumed to be a post- viral neuropathy, but this would not explain a left- sided preference unless the distal left recurrent laryngeal nerve (RLN) is somehow more suscepti- ble to viral attack than the right. Alternately, there may be some mechanism in which sudden neck extension or other postural change causes the left RLN to be stretched around the aorta. There may also be differences in intrathoracic connective tissue near the aorta that predispose to this sort of injury.

Skull base tumor . This finding may simply be related to the relatively low number of patients in this series. 18 We can find no references indicating a biological explanation for a left-sided predilection for skull base tumors. Time to Presentation To our knowledge, this study is the first large series to investigate time to presentation of these patients. It was found that three-fourths of patients with UVFP seen at the WUSM present within 3 or 4 months of the onset of symp- toms. While this is encouraging, it also indicates that there

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