Benjamin Bruce
Departments of Otolaryngology and Head and Neck Surgery, Sydney UniversitySydney, Australia.
ANZ J Surg. 2003 Oct;73(10):784-6. doi: 10.1046/j.1445-2197.2003.02799.x.
Felix Semon's 'laws' of vocal cord paralysis were conceived over a century ago, based on the simple concept that abductor function of the recurrent laryngeal nerve was more vulnerable than adductor function. It is now clear that the neuromuscular pathology of laryngeal innervation is much more complex. Whether the nerve has been cut, crushed, stretched, cauterized or otherwise injured, it is seldom completely transected. There might be no detectable vocal cord movement at laryngoscopy, yet, electromyography usually shows at least some activity because of incomplete denervation and/or developing synkinesis. Electrical silence hardly ever persists forever. Disordered vocal fold movement following nerve injury appears to depend on laryngeal synkinesis with disorganized neuromuscular function caused by misdirected regeneration and aberrant reinnervation, sometimes by adjacent nerves. The severity of the injury, abnormal random reinnervation, scar tissue formation and nerve growth-stimulating and inhibiting factors influence the final position of the vocal fold. For a better understanding of neurolaryngological disorders it is no longer sufficient to think merely in terms of 'vocal cord paralysis'.
费利克斯·西蒙关于声带麻痹的“定律”是在一个多世纪前提出的，其基于一个简单的概念，即喉返神经的外展功能比内收功能更易受损。现在很清楚，喉神经支配的神经肌肉病理学要复杂得多。无论神经是被切断、挤压、拉伸、烧灼还是以其他方式损伤，很少会完全横断。喉镜检查时可能没有可检测到的声带运动，然而，由于去神经不完全和/或出现联带运动，肌电图通常至少会显示一些活动。电静息几乎不会永远持续。神经损伤后声带运动紊乱似乎取决于喉联带运动，其由再生方向错误和异常再支配导致神经肌肉功能紊乱引起，有时是由相邻神经所致。损伤的严重程度、异常的随机再支配、瘢痕组织形成以及神经生长刺激和抑制因素都会影响声带的最终位置。为了更好地理解神经喉科学疾病，仅仅从“声带麻痹”的角度去思考已不再足够。
