Sercarz J A, Berke G S, Ming Y, Rothschiller J, Graves M C
UCLA School of Medicine, Division of Head and Neck Surgery.
Otolaryngol Head Neck Surg. 1992 Nov;107(5):657-68. doi: 10.1177/019459989210700508.
Adductor spasmodic dysphonia is a vocal disorder of uncertain etiology with no satisfactory long-term treatment. Recently, injection of botulinum toxin (Botax) into the thyroarytenoid (TA) muscle has been used as an effective temporary treatment. A surgical counterpart to bilateral TA Botox injection is described in this article. Bilateral thyroarytenoid denervation was performed through a window in the thyroid cartilage in seven canines, including four that were studied 3 months after the procedure. No serious complications occurred in the animals, each maintaining full vocal fold abduction and adduction. In all cases, anticipated physiologic changes in laryngeal function were observed, including the inability to generate high subglottic pressures during high levels of laryngeal nerve (RLN) stimulation. In two of the surviving animals, the ansa cervicalis was used to reinnervate the TA muscle, thereby preventing the possibility of reinnervation from the proximal RLN stump while limiting TA atrophy and fibrosis. Bilateral TA denervation represents a hopeful new long-term approach to spasmodic dysphonia treatment.
内收肌痉挛性发音障碍是一种病因不明的发声障碍，尚无令人满意的长期治疗方法。最近，向甲杓肌注射肉毒杆菌毒素已被用作一种有效的临时治疗方法。本文介绍了一种与双侧甲杓肌肉毒杆菌毒素注射相对应的手术方法。通过甲状软骨上的一个窗口对7只犬进行了双侧甲杓肌去神经支配术，其中4只在术后3个月接受了研究。动物未出现严重并发症，每只动物的声带均保持完全外展和内收。在所有病例中，均观察到预期的喉功能生理变化，包括在高喉返神经刺激水平下无法产生高的声门下压力。在两只存活的动物中，利用颈袢重新支配甲杓肌，从而防止近端喉返神经残端重新支配的可能性，同时限制甲杓肌萎缩和纤维化。双侧甲杓肌去神经支配是痉挛性发音障碍治疗一种有希望的新的长期方法。
