[Treatment of Perioperative Unilateral Paralysis of the Vocal Fold in Thoracic Surgery: the Value of Early Augmentation of the Vocal Fold].

Unilateral perioperative paresis of the vocal fold (eSLP) in thoracic surgery harbours the risk of clinically relevant complications for the affected patients as a result of restrictions to vocal function. In addition to conservative voice therapy (speech therapy), vocal fold augmentation (SLA) offers an option for interventional therapy. The indication and timing are not handled uniformly and require expertise in phoniatric-phonosurgical.In a retrospective study, patients with a first diagnosis of eSLP before or after thoracic surgery with curative treatment intention in the period from 01/2010 to 12/2020 were analysed. The primary endpoint was defined as the time of SLA including the augmentation result. Secondary endpoints were the occurrence of eSLP, the indication for SLA and possible complications.Of a total of n = 939 included cases, eSLP was documented in n = 44 (4.7%) patients. Differentiation was made according to tumour entity: lung carcinoma n = 21 (47.7%), lung metastases n = 8 (18.2%), mediastinal tumour n = 13 (29.5%) and malignant pleural mesothelioma n = 2 (4.6%). While SLP was already present preoperatively in n = 15 patients, postoperative SLP occurred in 66% of cases (n = 29). Early SLA with hyaluronic acid was performed in n = 16 (36.4%) patients in the first postoperative days. SLA was indicated for vocal fold paresis in the paramedian (56%) or intermediate (31%) position with pronounced glottic closure insufficiency (100%) and clinically severe hoarseness (93.6%). The intervention achieved a medialisation of the paretic vocal fold in all cases and thus improved glottic closure. This led to an improvement in vocal tone and coughing.An eSLP occurred in 4.7% of cases in thoracic surgery and was successfully treated in 36% of cases during hospitalisation by means of complication-free SLA. An eSLP should be clarified at an early stage and, if indicated, promptly evaluated for early SLA.