Fleischer Susanne, Schade Götz, Hess Markus M
Department of Phoniatrics and Pediatric Audiology, University Hospital Eppendorf, University of Hamburg, Hamburg, Germany.
Ann Otol Rhinol Laryngol. 2005 Jun;114(6):488-93. doi: 10.1177/000348940511400611.
To evaluate the endoscopic criteria of recurrent laryngeal nerve disorders, we performed a retrospective evaluation of videolaryngoscopic recordings from 50 patients with recurrent laryngeal nerve disorders.
The videolaryngoscopic examination was performed with rigid and flexible endoscopes. The range of motion of three laryngeal structures was assessed: the vocal ligament, the vocal process, and the arytenoid "hump" (mainly the corniculate region).
Comparison of movement of these three structures revealed discrepancies. In 16 of 45 patients (36%) rigid endoscopy showed movements of the arytenoid hump associated with absence of any mobility of the vocal process and vocal ligament. In 5 patients the extent of movement of the vocal process and vocal ligament was less than that of the arytenoid hump. Only in 24 of 45 cases were the ratings for the vocal process, vocal ligament, and arytenoid hump identical. The findings of fiberscopy were comparable.
In assessing recurrent laryngeal nerve disorders via laryngoscopy, sole judgment of the arytenoid hump movement can mislead. Our interpretation suggests that visible movement of the mucosa covering the arytenoid and accessory cartilages is not always paralleled by movement of the arytenoid cartilage itself. It was shown that the best criterion to rely on in endoscopy is movement of the vocal process or the vocal ligament.
为评估喉返神经障碍的内镜检查标准，我们对50例喉返神经障碍患者的电子喉镜录像进行了回顾性评估。
使用硬质和柔性内镜进行电子喉镜检查。评估了三个喉部结构的活动范围：声带韧带、声带突和杓状软骨“隆突”（主要是小角软骨区域）。
这三个结构的活动比较显示存在差异。在45例患者中的16例（36%），硬质内镜检查显示杓状软骨隆突有活动，而声带突和声带韧带无任何活动。在5例患者中，声带突和声带韧带的活动程度小于杓状软骨隆突。在45例病例中，只有24例声带突、声带韧带和杓状软骨隆突的评级相同。纤维喉镜检查结果与之相似。
通过喉镜检查评估喉返神经障碍时，仅根据杓状软骨隆突的活动进行判断可能会产生误导。我们的解释表明，覆盖杓状软骨及附属软骨的黏膜的可见活动并不总是与杓状软骨本身的活动平行。结果表明，内镜检查中最可靠的标准是声带突或声带韧带的活动。
