Ultrasound Diagnostic Value in Assessment of Vocal Cord Mobility before Neck Surgery

Abstract
Background: The preoperative assessment of vocal cord mobility in patient scheduled for neck surgery is mandatory. The diagnostic approach differs from traditional ones as flexible fiberoptic, indirect laryngoscopy, to less tradition ones as CT and MRI.
Ultrasound is non invasive, safe, repeatable, bedside, non ionizing radiation dependent technique together with the advancement of technology providing high resolution real time images and short cine videos. This is hand to hand with good patient compliance for the technique.
Aim of Study: To evaluate the diagnostic value of ultra-sound in the assessment of vocal cords mobility before neck surgeries.
Patients and Methods: This cross section study was carried out between October 2016 and November 2018 on 60 patients (25 males and 35 females) in Ain Shams University Hospitals. They were all scheduled for neck surgeries for different reasons. After taking full clinical history, complete head and neck examination, flexible fiberoptic and/or indirect laryn-goscopy, patients underwent sonographic examination. Patients were divided into two groups. The first group (I) with no clinical symptoms or signs suggestive of vocal foldparalysis. The second group (II) with unilateral abductor vocal fold paralysis. The acquired static photos and dynamic cine videos were accurately examined to delineate various laryngeal structures and to assess interarytenoid distances and arytenoid cartilage mobility during full inspiration and during phonation.
Results: After identification of laryngeal structures, we could identify in recorded cine videos immobile arytenoids cartilage on the paralytic side during both inspiration and phonation with sensitivity (80%), specificity (90%), PPV (80%) and NPV (90%). Another important finding is noted that the percent of change in interarytenoid distances was much less in group II than in group I.
Conclusion: Preoperative ultrasound examination of vocal cord mobility proved to be valid identifying the various laryngeal structures with high potency in judging vocal cord mobility either by short real time cine videos or measuring interarytenoid distances. We recommend to consider laryngeal ultrasound as reliable imaging modality in preoperative as-sessment of vocal cord mobility prior to neck surgery.