Extracranial internal carotid artery tortuosity may cause vocal cord palsy

Abstract

Background: Clinical practice made us suspect that vocal cord palsy (VCP) can be associated with extracranial internal carotid artery (ICA) tortuosity.

Objectives: To find evidence for a causative relation between ICA tortuosity and VCP.

Methods: This single-center, retrospective study comprised 66 patients with VCP. A total of 45 patients without VCP served as control group. Patient charts were reviewed for etiology and side of VCP. CT scans were reviewed independently by two radiologists for imprint in the jugular vein (JV) caused by a tortuous ICA, considered an indirect sign of potential vagus nerve affection.

Results: A total of 33 patients had idiopathic VCP. ICA tortuosity causing a JV imprint with >10% JV lumen reduction was found more frequently on the paretic sides of patients with idiopathic VCP (15–24%) than in controls (3–9%), with p<.05 for observer 2 and p=.07 for observer 1. In patients with idiopathic VCP and JV imprint with >10% JV lumen reduction on one or both sides (n = 9), both observers found JV imprint with >10% JV lumen reduction more frequently on the side of VCP (p<.05).

Conclusions: ICA tortuosity causing a JV imprint may be the cause of VCP in some of the cases of VCP currently regarded as idiopathic.

Chinese abstract

背景：临床经验让我们意识到声带麻痹（VCP）可能与颅外颈内动脉（ICA）折曲有关。

目标：寻找ICA折曲与VCP之间因果关系的证据。

方法：这项单中心回顾性研究涉及66名VCP患者。共45名无VCP的患者作为对照组。对病人图表进行了有关VCP的病因和麻痹侧面的审查。由两名放射科医师独立审查CT扫描, 以寻找由折曲的ICA引起颈静脉（JV）的印记。它被认为是潜在的迷走神经感染的间接征兆。

结果：共有33名患者患有特发性VCP。特发性VCP（15-24％）患者的麻痹侧比对照组（3-9％）更多地发现ICA折曲引起的JV印记, JV流明减少> 10％。对于观察者2, p <0.05；对于观察者1, p = 0.07。对于有特发性VCP和JV印记的患者, 在一侧或两侧的JV流明减少> 10％（n = 9）, 两位观察者都发现JV印记的JV流明减少> 10％, 在VCP一侧更频繁出现（p <0.05）。

结论：导致JV印记的ICA折曲可能是VCP的导因, 也是目前被视为特发性的一些VCP病例的原因。

Keywords:

• Vocal cord paralysis
• carotid artery diseases
• multidetector computed tomography
• recurrent laryngeal nerve
• vagus nerve diseases

Acknowledgments

The authors thank Preben Homøe DMSc for his support.

Disclosure statement

The authors report no conflict of interest.