Zheng Hongliang, Zhou Shuimiao, Li Zhaoji, Chen Shicai, Zhang Suqin, Wen Wu, Shen Xiaohua, Liu Feng, Huang Yideng, Cui Yi, Geng Liping
Department of Otorhinolaryngology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Zhonghua Er Bi Yan Hou Ke Za Zhi. 2002 Aug;37(4):291-5.
To investigate 5 procedures of laryngeal reinnervation for unilateral vocal cord paralysis induced by traumatic recurrent laryngeal nerve injury.
35 cases were selected for our study, all patients had unilateral recurrent laryngeal nerve injury, including 8 for nerve decompression, 6 for end to end anastomosis of recurrent laryngeal nerve, 16 for main branch of ansa cervicalis anastomosis to recurrent laryngeal nerve, 3 for nerve muscular pedicle and 2 for nerve implantation. All cases have been subjected to preoperative and postoperative voice recording, acoustic analysis, videolaryngoscopy, strobscopy and electromyography.
It is found the adductory and abductory motion of the vocal cord restored in 5 cases with less than 4 months course who received nerve decompression. Although functional motion of vocal cord was not seen in two patients who received nerve decompression with a course longer than 4 months and one less than 4 months, and in all cases who received ansa cervicalis anastomosis and end to end anastomosis of recurrent laryngeal nerve, these procedures resulted in medialization of vocal cord and the mass and tension of the reinnervated vocal cord may become much the same as the contralateral normal vocal cord, thus resuming symmetric vibration of the vocal cords and physiological phonation. Nerve muscular pedicle technique and nerve implantation enabled adductory muscles to be reinnervated, thus improving severe hoarseness, but they didn't restore normal voice.
(1) Nerve decompression seems to be the best procedure in laryngeal reinnervation; (2) Main branch of ansa cervicalis technique raises satisfactory reinnervation of adductor muscles; (3) Selection of the laryngeal reinnervation protocols should depend on the course, severity and type of nerve injury.
探讨5种喉再支配手术治疗外伤性喉返神经损伤所致单侧声带麻痹的效果。
选取35例单侧喉返神经损伤患者，其中8例行神经减压术，6例行喉返神经端端吻合术，16例行颈袢主支与喉返神经吻合术，3例行神经肌蒂移植术，2例行神经植入术。所有患者均接受术前及术后嗓音录音、声学分析、电子喉镜、频闪喉镜及肌电图检查。
病程小于4个月的5例接受神经减压术的患者声带内收及外展运动恢复。病程大于4个月及小于4个月的2例接受神经减压术的患者以及所有接受颈袢吻合术和喉返神经端端吻合术的患者未见声带功能运动，但这些手术使声带内移，再支配声带的质量和张力与对侧正常声带相近，从而恢复声带对称振动及生理性发声。神经肌蒂移植术和神经植入术可使内收肌重新获得神经支配，改善重度声嘶，但未恢复正常嗓音。
（1）神经减压术似乎是喉再支配手术中最佳术式；（2）颈袢主支技术可使内收肌获得满意的再支配；（3）喉再支配手术方案的选择应取决于神经损伤的病程、严重程度及类型。
