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The phrenic nerve is responsible for controlling the contraction of the diaphragm, which allows the lungs to take in and release air. Phrenic nerve damage often leads to deteriorating function of the diaphragm, which can lead to partial or complete paralysis of the muscle and, as a result, serious breathing problems. If the paralysis does not prevent a patient from breathing normally, it may be possible for the person to live normally, even with extensive damage to the nerve. Patients who experience breathing problems, however, may require emergency medical treatment or surgery.
Sudden, severe damage to the phrenic nerve can make it impossible for the diaphragm to contract on its own. In order to make sure that the patient can breathe, a breathing tube needs to be inserted, a process called intubation. Artificial respiration is then required. This type of nerve damage is most common as the result of certain heart surgeries or accident. It is possible for the damage to correct itself over time, though if a patient shows no sign of improvement, surgical treatment may be necessary.
In certain patients with phrenic nerve damage, installing a breathing pacemaker is one treatment option. This device, like a cardiac pacemaker, stimulates the regular contraction of the diaphragm through the use of a small electrical pulse. Patients must undergo training in order to adjust to life with the pacemaker. The device is not effective if a patient has damage in the intrathoracic part of the phrenic nerve.
A procedure called a diaphragmatic plication can also be used to correct for this damage. During the surgery, the diaphragm is folded in on itself and sutured back together again. This tightens the diaphragm, making it work more efficiently.
In most cases, phrenic nerve damage causes a problem on only one side of the diaphragm. A patient with nerve damage on both sides can have each side repaired through plication or can undergo two separate surgeries a few weeks apart. This surgery is an effective treatment for adults with chronic nerve damage as well as for newborns with congenital defects. Damage caused by surgery or an accident is also often treated through plication.
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