Marion M H, Klap P, Perrin A, Cohen M
Department of Otorhinolaryngology, Fondation Rothschild, Paris, France.
Lancet. 1992 Feb 22;339(8791):457-8. doi: 10.1016/0140-6736(92)91060-l.
Fibreoptic laryngoscopy in 6 patients with laryngeal stridor showed immobile vocal cords in a paramedian position but no other local cause. Thus a diagnosis of Gerhardt's syndrome, usually ascribed to paralysis of vocal-cord abductor muscles, was made in 3 patients who had no other signs or symptoms of dystonia, and in 3 patients who had multifocal dystonia. Electromyography (EMG) showed evidence of overactivity of vocal-cord adductors, with no evidence of denervation in the abductor muscles. Botulinum toxin injection of the overactive thyroarytenoid muscles abolished stridor. These clinical and EMG findings indicate that Gerhardt's syndrome is not caused by paralysis of vocal-cord abductors, but represents a focal laryngeal dystonia which may be treatable by botulinum toxin injections of vocal-cord adductor muscles rather than by arytenoidopexy or tracheostomy.
对6例喉喘鸣患者进行的纤维喉镜检查显示，声带固定于旁正中位，但未发现其他局部病因。因此，3例无其他肌张力障碍体征或症状的患者以及3例有多灶性肌张力障碍的患者被诊断为通常归因于声带外展肌麻痹的格哈特综合征。肌电图（EMG）显示声带内收肌活动过度，外展肌无失神经支配的证据。对过度活跃的甲杓肌注射肉毒杆菌毒素可消除喘鸣。这些临床和肌电图结果表明，格哈特综合征并非由声带外展肌麻痹引起，而是一种局灶性喉肌张力障碍，可通过对声带内收肌注射肉毒杆菌毒素而非杓状软骨固定术或气管造口术进行治疗。
