Esophageal regurgitation as a cause of inspiratory distress after thyroplasty

Abstract 

Objectives

Edema of the arytenoid and wound hematoma are principal causes of inspiratory distress after arytenoid adduction and type I thyroplasty. The purpose of the present study was demonstrate esophageal regurgitation one of the causes of inspiratory distress after thyroplastic surgeries.

Study design

Two case reports.

Methods

We encountered 2 patients with unilateral vocal fold immobility who required emergent tracheostomy owing to sudden inspiratory distress 1 to 2 days after completion of arytenoid adduction combined with type I thyroplasty.

Results

Their dyspneic attacks occurred just after taking a meal. Both had a history of esophagectomy with reconstruction of the food passage using a gastric tube. They had a sufficiently wide glottis as indicated by laryngeal fiberscopy. Videofluorography showed a stricture at the junction between the duodenum and the gastric tube and barium pooling above the stricture. Regurgitation of barium was also seen.

Conclusion

Based on these clinical courses and findings, laryngeal closure reflex triggered by esophageal regurgitation was considered to be the most possible cause of their dyspneic attacks. Phonosurgeons considering thyroplastic surgeries for postesophagectomy patients should be aware that esophageal regurgitation possibly causes laryngeal closure reflex resulting in inspiratory distress during the postoperative period.