Vocal fold fixation caused by penetration of a high-velocity steel projectile

January 21, 2014
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Abstract

Vocal fold fixation as a result of trauma caused by a foreign body is rare. We report a unique case of vocal fold fixation caused by traumatic penetration of a shard of steel in a 31-year-old steelworker. While the patient was at work, an airborne projectile suddenly pierced his neck and entered his larynx, causing progressive hoarseness and dyspnea. Flexible laryngoscopy detected no obvious foreign body, but it did reveal that the right vocal fold had become immobile. Computed tomography revealed that a 2.5-cm sliver of steel had become impacted in the right cricoarytenoid joint, which made the arytenoid cartilage unable to rotate. An emergency tracheostomy was performed with local anesthesia to construct a functioning airway, and then rigid laryngoscopy was performed with general anesthesia. The foreign body was removed with the assistance of a microscope and microscissors. Postoperatively, the patient immediately regained control of his right vocal fold, and he experienced no permanent injury.

Introduction

The vast majority of cases of vocal fold immobility are caused by recurrent laryngeal nerve paralysis.1-7 To the best of our knowledge, only 2 cases caused by mechanical fixation have been previously reported in the literature.8,9 As far as we know, no case of vocal fold fixation caused by traumatic penetration of a foreign body has been reported. In this article, we describe such a case.

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