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Q. My friend got vocal cord problem after neck surgery. Which doctor should we follow now?

Answered by
Dr. Rajyaguru
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 15, 2017 and last reviewed on: Oct 09, 2018

Hello doctor,

My friend is 30 years old. She had a neck schwannoma tumor, and that was completely removed by surgery. Post surgery, my friend could not eat or drink anything. Her voice was hoarse as well. ENT doctor followed up her and noted that her right vocal chord was paralyzed, but not the left. For her feeding, they installed a G-tube in the abdomen to give her feed from as she could not tolerate it through her mouth or nose. The ENT did the micro laryngoscopy and gave her a temporary injection to bring her right vocal chord closer, so her voice improves and encourage water intake. After three days of this procedure, she tried in the evening time to drink water and little by little; she finished half a glass. She has too much gagging that gives her a feeling of choking. When she clears her throat, the gagging looks like super sticky clear glue, and she constantly has it. The next morning she tried to drink water little by little, but she was getting aspiration. So, she got discouraged and depressed to a severe level. It is now 48th day since the removal of her tumor, and there does not seem to be any sign of her swallowing. I want to know if this is temporary or permanent. We got a couple of opinions from doctors that we sent her surgery report to and they think she can recover anytime between three to six months. The doctor who did the surgery is a vascular surgeon, and he also believes that she will recover from two to three months and will start eating and drinking slowly.

I have asked the doctor about the nerve damage or cut. He said that he was not sure about the exact nerve, but seemed like a branching nerve. When I asked him if it was 10th or 12th nerve, he said it was the 12th branching nerve. The ENT doctor said 10th nerve, and it can be permanent damage. The vascular surgeon did say that they repaired the nerve and did not leave it like that. She is currently on Lorazepam, Sodium bicarbonate, Cotazym, Tylenol, Centrum and Ranitidine. At this point, I do not know what to believe anymore and what to think. I believe nerve specialists are neurologists and hence, I am here. Any of your help would be greatly appreciated. Thank you.

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Hi,

Welcome to icliniq.com.

  • The issue here is that you have not been explained preoperatively well about the possible differentials of that tumor in the neck and I would not say that your doctors are at fault because the situation and the case scenario was like that.
  • Preoperatively, from all the investigations;, the tumor looked like one coming from the blood vessel and so was operated by a vascular surgeon without mentally preparing the patient and family about post operation problems of speech and swallowing.
  • But, contrary to pre-op workup; the tumor turns out to be a schwannoma. Only a biopsy report could confirm this, so again, the doctor is not to be blamed.
  • Now schwannomas are entirely different. They arise from the part of the nerve itself and so; however carefully we remove it we end up producing some nerve damage.
  • So for sure, her nerve is damaged, though partially, both 10th more than 12th is damaged. Her gag reflex is present so that we can hope for recovery maybe by six months.
  • Your surgeon has attempted nerve repair also, so if she continues vocal exercises as advised by the speech therapist, then she may have some help in recovery. We have these nerves both the sides and so the other side tries to compensate.
  • Now, at this point, you should follow the speech therapist and ENT surgeon. If there is no sign of recovery, then you should meet an ENT specialist and plan for some surgical or non-surgical intervention for restoration of 10th and 12th nerve functions.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Hi doctor,

In the end, I want to know whether the nerve can grow back and she gets to swallow again or if it does not. Can we get nerve graft? What is the success rate for that? I cannot imagine that someone can live and die in this condition particularly when medical science is now in this day and age.

#

Hi,

Welcome back to icliniq.com.

  • Yes, the nerve can grow back. There are chances that it will grow back, especially when your surgeon says that he has sutured it.
  • In spite of recovery, the vocal cord may not become completely normal. This recovery would be seen by three months maximum.
  • If it does not recover at all, then you can opt for nerve graft or connecting another nerve to the vocal cord nerve (recurrent laryngeal). The chances of recovery after this are approximately 40%.
  • Each case will vary highly in outcomes depends on the nerve damage, the way of suture, the exact location of the injury, etc.
  • Other than nerve repair and grafting, thyroplasty and Teflon injection are the two procedures, which can help her regain the proper position of paralysed vocal cord. These are done by head and neck surgeons.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Hi doctor,

Besides the vocals, will the epiglottis move again? Can her swallowing come back? Yes, the surgeon said that he repaired the nerve the tumor was going through. She has a lot of gagging with a sticky saliva. Is this because of nerve cut? Or is that more to do with her neck muscle repair?

#

Hi,

Welcome back to icliniq.com.

  • I never said that she would suddenly have better voice and swallowing. I do not give false hopes. I hope you understand.
  • She will recover slowly, and the improvement will be of a small amount over weeks.
  • The procedures are directed towards repairing of vocal cords, so epiglottis will not change. But, still, after swallowing training, she can swallow without aspirations. The ENT surgeons would be the best people to explain you this because they do that procedure.
  • Gagging is because of nerve damage, and so is the sticky saliva. It is the reduced amount of saliva production, which is perceived as sticky saliva. I am not sure whether that would improve.
  • Some people could never eat again after such nerve problems. But, younger and otherwise healthy patients do improve.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


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