Lost for words

01 March 2008

A 72-year-old man, Mr V, presented to his GP with a persistent "tickly cough" over the course of a year. The GP examined the patient and found he had an unusually long uvula and referred him to a consultant otolaryngologist, Mr A.

The consultant arranged a barium swallow before proceeding with an operation to reduce Mr V's uvula.

X-ray images from the barium swallow revealed that Mr V also had a pharyngeal pouch. The patient asked the consultant if he could live with the pouch untreated. Apart from a slight gurgling sensation in his throat Mr V had not experienced any noticeable symptoms such as dysphagia, regurgitation or halitosis. Mr A advised strongly that he should go through with pharyngeal pouch surgery as it might be more problematic if left to later years.

Mr V claimed he asked specifically about complications, risks or side-effects of the procedure. Mr A had replied that there was no risk as it was a simple operation done with a laser through the mouth.

After the operation Mr V was informed that laser treatment had not been possible and that Mr A had to resort to using a scalpel. The surgeon also admitted that in the course of the operation he had 'clipped the muscle', but he assured Mr V that his voice would recover.

Twelve months later and after extensive speech therapy it was apparent that the surgical damage had left Mr V with a permanent left-sided laryngeal nerve palsy and a paralysed left vocal fold. He can no longer sing and by the end of each day suffers from vocal fatigue. Mr V also now spontaneously regurgitates food and liquids.

Analysis and outcome

A letter of claim was received by Mr V from solicitors acting on behalf of the patient. Expert opinion in the case was of the view that the procedure had not been necessary given the symptoms. Recurrent laryngeal nerve palsy is a recognised complication of the pharyngeal pouch surgery but the fact that Mr A did not record on the consent form any discussion of the potential complications constituted negligence on his part.

The case was settled with costs.

Key points

• Ensure formal consent for surgical procedures in informed.
• Record discussions of risks and possible complications of surgical procedures.
• Consider carefully whether a surgical procedure is justified.

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