A case of vocal cord paralysis following mobilisation of the internal mammary artery is described. Of the various possible mechanisms, the most likely in this case is damage to the vagus nerve in the root of the neck, where it passes close to the origin of the internal mammary artery. Diathermy may have caused the damage, and this may be avoided by using a disposable automatic clip applier on any branches of the mammary artery in the area.
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