Isolated vocal-cord paralysis following blunt trauma to the chest.

A 20-year-old white man sustained a concussion and compression of his chest under a truck during a vehicular accident. The initial chest roentgenogram was significant in that it demonstrated slight widening of the mediastinum, fracture of the right fifth rib, and compression fractures of the lower three thoracic vertebrae. Three days after the accident, the patient's level of consciousness had improved enough that he was conversing freely; and his father, who was a physician, noted that the patient was hoarse. Seven days after the accident, the hoarseness originally attributed to laryngeal edema had not improved, and indirect laryngoscopic examination revealed left vocal-cord paralysis. The patient was transferred to the Milton S. Hershey Medical Center on the next day because of the suspicion of serious associated intrathoracic injury. Upon arrival the patient was alert and oriented, with stable vital signs. His hematocrit reading was 41.1 percent, and the white blood cell count was 5,900!cu mm. Indirect laryngoscopic. examination confirmed left vocal-cord paralysis and the absence of direct laryngeal injury. An aortogram revealed a normal thoracic and abdominal aorta. Bronehoscopic examination revealed a linear contusion 'with submucosal hemorrhage across the origins of both the right and left main-stem bronchi, The patient was discharged from the hospital on the day after the aortogram was taken. Eight weeks following the accident, the patient's hoarseness cleared overnight, and laryngeal examination now shows normal left vocal-cord mobility.