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

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 postoperative 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.

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.

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.

yes; you got it right. The nerves involved with the speech and swallowing functions are very sensitive. ..even if they are just stretched; they loose their function. we encounter this stretching problem during other brain tumor surgery also. Just mild to moderate stretching and they stop functioning for 3 weeks or so. But they do recover eventually when they are just stretched and have dysfunction due to that. I don't have theoretical statistics for that but even yesterday we had a patient who came for follow up; young girl who had the same issue(nerve dysfunction due to stretch)...she even needed tracheostomy! and now she is eating and talking normally!