Joshua Benzion, Feinmesser Rafael, Zohar Liza, Shvero Jacob
Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
Isr Med Assoc J. 2004 Jun;6(6):336-8.
Laryngeal obstruction due to bilateral vocal cord immobility in adduction may cause dyspnea, hoarseness and dysphagia and can lead to dependence on a tracheostomy. Treatment poses a challenge because of the opposing functions of the larynx and the risk of neck and laryngeal tissue damage.
To describe our experience with endoscopic CO2-laser-assisted posterior ventriculocordectomy without tracheostomy for the treatment of bilateral vocal cord immobility in adduction.
The study group consisted of five male and five female patients aged 17-81 years. The procedure was performed with an endoscope and operating microscope connected to a CO2 laser. A C-shaped incision was made, and the posterior third of one vocal cord, the vocal process of the arytenoid, and the posterior third of the false vocal cord were excised. Tracheostomy was not performed.
The technique allowed for a convenient approach to the difficult-to-view areas of the larynx. The procedure was short and bloodless, with minimal damage to laryngeal tissue and no local edema. Hospitalization time was short. Postoperatively, patients had sufficient breathing and mostly fair to good voice quality. None of the patients had severe aspirations and only three patients had mild aspirations.
We recommend this procedure for patients with bilateral vocal cord immobility prior to tracheostomy. Delaying surgery beyond the time of possible re-innervation may place the patient at risk of decompensation, which requires tracheostomy.
双侧声带内收固定导致的喉梗阻可引起呼吸困难、声音嘶哑和吞咽困难，并可能导致依赖气管造口术。由于喉部功能相互矛盾以及颈部和喉部组织损伤的风险，治疗具有挑战性。
描述我们在内镜下二氧化碳激光辅助下进行后室带切除术且不进行气管造口术治疗双侧声带内收固定的经验。
研究组包括5名男性和5名女性患者，年龄在17至81岁之间。手术使用连接二氧化碳激光的内窥镜和手术显微镜进行。做一个C形切口，切除一侧声带的后三分之一、杓状软骨的声带突和假声带的后三分之一。未进行气管造口术。
该技术便于接近喉部难以观察的区域。手术时间短且无出血，对喉部组织损伤最小，无局部水肿。住院时间短。术后，患者呼吸充足，声音质量大多为中等至良好。无一例患者有严重误吸，仅3例患者有轻度误吸。
对于双侧声带固定的患者，我们建议在气管造口术前采用此手术。手术延迟超过可能重新支配的时间可能使患者面临失代偿风险，这需要进行气管造口术。
