Unilateral high vagal paralysis: Relationship of the severity of swallowing disturbance and types of injuries

Objective: To evaluate the prognoses of high vagal lesions and their association with their clinical presentation, and seek to determine the best strategy of management for each patient. Study Design: Retropective case series with chart review. Materials and Methods: Patients following laryngoplasty from 2001 to 2008 at a tertiary referral voice and swallowing center in Taiwan were reviewed. They were divided into two groups according to the etiologies of high vagal trauma. The pre- and posttreatment voice and swallowing functions were reviewed; swallowing status was compared between patient groups. Results: Of 186 consecutive patients who underwent laryngoplasty, 8 females and 9 males were diagnosed of unilateral high vagal damage. One group of 11 patients suffered vagal damaging suddenly from skull base trauma, cerebrovascular accidents, and surgical complications; symptoms of vagal paralysis occurred immediately after those events. The second group was comprised of six patients who lost their high vagal functions gradually from a skull base tumor or mass compression. Feeding tube status was significantly different between the groups. All except one patient in group 2 recovered their voice and swallowing abilities after appropriate laryngoplasty. Conclusions: High vagal nerve damage from skull base surgery or trauma leads to a higher incidence of feeding tube dependency than that from skull base tumor compression. Patients can be treated successfully with an appropriate injection or medialization thyroplasty. Immediate laryngoplasty is suggested for cases right after skull base surgery or trauma.