Remacle Marc, Plouin-Gaudon Isabelle, Lawson Georges, Abitbol Jean
Department of ENT and Head and Neck Surgery, University Hospital of Louvain at Mont-Godinne, Therasse avenue 1, 5530, Yvoir, Belgium.
Eur Arch Otorhinolaryngol. 2005 Oct;262(10):871-4. doi: 10.1007/s00405-004-0897-7. Epub 2005 Feb 26.
The symptoms of adductor spasmodic dysphonia are most commonly palliated by periodic botulinum toxin injections. The need for repeated injections, difficulty in obtaining injections and cost make this form of treatment intolerable for some patients. To address these concerns, we propose a new treatment approach utilizing trans-oral recurrent nerve coagulation. The goal is to weaken the force of laryngeal closure during spasms by creating fibrosis of the terminal branches of one recurrent nerve through coagulation. Under general anesthesia without paralysis, an electrical stimulator is used to identify the region within the thyroarytenoid muscle that produces the greatest contraction with minimal stimulation. The radiofrequency laryngeal probe or electrocautery device is introduced into this position, and energy is delivered. The location of the region of maximal stimulation is usually just lateral and anterior to the vocal process of the arytenoids. Between 1989 and 2000, seven patients were treated with electrocautery. To achieve remission of spasms, three patients needed three sessions, four needed two sessions and one only one session. Since 2001, three patients have achieved remission of spasms with a single treatment with radiofrequency during which 80 J was delivered. Voice results are comparable to those obtained with botulinum toxin. Initially, the voice is breathy and laryngeal examination shows complete vocal fold immobility. After 1-2 months, the voice improves and examination reveals unilateral hypomobility. Trans-oral recurrent nerve coagulation is an effective alternative to botulinum toxin injections.
内收肌痉挛性发音障碍的症状最常通过定期注射肉毒杆菌毒素得到缓解。但反复注射的需求、注射困难以及费用问题使这种治疗方式对一些患者来说难以忍受。为解决这些问题，我们提出一种利用经口喉返神经凝固术的新治疗方法。其目的是通过凝固使一条喉返神经的终末分支形成纤维化，从而在痉挛时减弱喉部闭合的力量。在非麻痹状态下的全身麻醉下，使用电刺激器确定在甲状杓肌内以最小刺激产生最大收缩的区域。将射频喉探头或电灼设备插入该位置并输送能量。最大刺激区域的位置通常恰好在杓状软骨声带突的外侧和前方。1989年至2000年期间，7例患者接受了电灼治疗。为实现痉挛缓解，3例患者需要3次治疗，4例需要2次治疗，1例仅需1次治疗。自2001年以来，3例患者通过单次射频治疗实现了痉挛缓解，治疗过程中输送了80焦耳能量。语音效果与肉毒杆菌毒素治疗相当。最初，声音呈喘息样，喉镜检查显示声带完全固定。1至2个月后，声音改善，检查显示单侧活动减弱。经口喉返神经凝固术是肉毒杆菌毒素注射的一种有效替代方法。
