Figure 2 shows our general principle in the management of patients with vocal fold palsy (VFP) following esophagectomy (Figure 2). Once the diagnosis of bilateral VFP was confirmed, each patient was examined for signs of airway obstruction. If the patient showed a significant sign of airway obstruction with bilateral VFP, two types of treatment were considered: (1) securing airway (for example, intubation) and (2) urgent tracheostomy keeping them nil per os (NPO) until respiratory problems are under control. For patients with no sign of airway obstruction, oral feeding was considered depending on examinations including esophagogastroduodenoscopy (EGD), modified barium swallowing (MBS) test, or esophagography. Then, oral ingestion was started in combination with several rehabilitation methods such as (1) tongue holding maneuver, (2) head tilt exercise, (3) Shaker's exercise, (4) deep pharyngeal neuromuscular stimulation, and (5) thermal tactile stimulation.

Management of bilateral RLNP following esophagectomy. RLNP, recurrent laryngeal nerve paralysis; EGD, esophagogastroduodenoscopy; MBS, modified barium swallowing test; TPN, total parenteral nutrition

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