Indirect laryngoscopic evaluation of vocal cord function in patients undergoing transhiatal esophagectomy.

Vocal cord function was assessed by indirect laryngoscopy before and after transhiatal esophagectomy for carcinoma of the middle and lower esophagus. Unilateral vocal cord palsy was found in 16 (34 percent) of 47 patients, but three of these patients were not hoarse and coughed normally. Four patients were hoarse postoperatively but had normal vocal cord function on indirect laryngoscopic examination. All vocal cord palsies but one were on the left side and the left side of the neck was used for esophageal mobilization with the only exception of the one patient who had a right cord palsy after a right-sided neck dissection. Patients with impaired vocal cord function did not have a significantly increased stay in the intensive therapy unit or in the hospital, nor was there an increase in pulmonary complications. Vocal cord palsy is a recognized complication of transhiatal esophagectomy, and although it remains unresolved whether or not the recurrent laryngeal nerve damage occurs at the level of the aortic arch or in the neck, the present evidence suggests the latter site. The clinical impression of postoperative vocal cord palsy is often incorrect.