Bilateral vocal cord palsy after total thyroidectomy-A new treatment-Case reports

INTRODUCTION: Dyspnea due to bilateral vocal cord palsy after total thyroidectomy (BVCPATT) is a life-threatening complication; nevertheless, we try to avoid tracheotomy. METHODS: Using normalized glottal area (NGA), we retrospectively studied 14 patients with BVCPATT. Nine patients without dyspnea were treated conservatively, while five with dyspnea received immediate bilevel positive air-way pressure (BiPAP) treatment. Both right and left recurrent nerves were grossly intact during surgery. RESULTS: The mean NGA during inspiration of five patients with dyspnea was less than that of nine patients without (6.21 +/- 1.57 (mean +/- standard deviation) vs. 20.5 +/- 9.5; p = 0.001). The mean age of patients with dyspnea was more than that of patients without (61.6 +/- 15.6 vs. 38 +/- 10.2; p = 0.007). Five patients with dyspnea that occurred at 0-8 days post operation recovered within 3-17 days after BiPAP. CONCLUSION: Dyspnea occurred in patients with BVCPATT who were relatively older. The mean NGA during inspiration in patients with dyspnea was less than that in patients without. BiPAP might be a new treatment for dyspnea. (C)2017 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license ((http://creativecommons.org/licenses/by-nc-nd/4.0/)