Vocal Cord Paresis as Sequela of Deep Neck Space Infection

Emmanuel Tadeus  S. Cruz,; Diane  D. Diamante,

Vocal Cord Paresis as Sequela of Deep Neck Space Infection

Diane D. Diamante | Emmanuel Tadeus S. Cruz

Abstract:

Objective: To report a case of vocal cord paresis in a patient with deep neck infection and to present its clinical course, manifestations, diagnostics, treatment and prognosis. Methodology Design: Case study Setting: Tertiary private hospital Patient: 1 Case Report JV 47 years old male was admitted because of swelling of the left lateral neck. Three weeks ago, the patient developed 3x3 cm swelling on the left infrauricular area which gradually enlarged to 10x9 cm extending to the left lateral neck. He developed dysphonia but no dyspnea. This prompted consultation and subsequent admission. The initial diagnosis was vocal cord paralysis with deep neck space infection secondary to uncontrolled diabetes. In the ward, hoarseness persisted and video laryngoscopy showed left vocal cord paresis. Neck swelling progressed with crepitations on palpation. Neck CT scan revealed gas forming infection with extensive infiltration on the left side of the neck causing a large mass effect, hence, cervical necrotizing fasciitis was considered. He was started on triple antibiotic therapy and underwent wound debridement. After three weeks, the patient improved and was discharged. Six months later, his voice fully recovers with no hoarseness until last follow up. Conclusion Although rare, patients with deep neck space infection may develop transient or temporary vocal cord paresis such as seen in this case. This is due to the proximity of the larynx and the vital structures responsible for phonation to the deep neck spaces which may be affected. Appropriate antibiotic and control of blood sugar are essential. Meticulous and utmost care should be exercised during surgical exploration to avoid iatrogenic injury to the vocal cord and laryngeal nerves.

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