Sarvat Marcos, Steffen Nédio, Costa Henrique Olival, Pontes Paulo
Instituto de Laringologia e Voz do Rio de Janeiro, 22271-020 Botafogo, Rio de Janeiro, Brazil.
J Voice. 2009 Sep;23(5):619-24. doi: 10.1016/j.jvoice.2008.01.013. Epub 2008 Jul 10.
Current surgical techniques for laryngeal exposure pose distinct limitations. To address these issues, this article describes a novel surgical technique. Our technique, termed Transventricular Chondroplastic Laryngotomy, allows for extensive and direct external access to the endolarynx. This procedure is described in both a cadaver and animal models. Three pigs were submitted to thyroid cartilage window opening without touching the laryngeal ventricle, and seven animals were submitted to the full procedure, opening a thyroid cartilage window with wide ventricular opening. The animals were sacrificed 20 days following the procedure. Prior to sacrifice, all animals underwent laryngoscopic examination and following euthanasia, the larynx and cervical regions were examined grossly, in addition to histologically. This surgery allowed for extensive exposure of the ipsilateral vocal fold and the contralateral hemilarynx, through the laryngeal ventricle, and thus enabled bi-instrumental handling of the vestibular fold, laryngeal ventricle, and from the anterior commissure to the arytenoids, bilaterally. No postoperative complications were observed. Access to the ventricle was easily and directly achieved through the thyroarytenoid muscle. We hypothesize that transventricular chondroplastic laryngotomy will emerge as the surgical technique of choice in patients presenting with difficult exposure and/or traditional surgical instruments are not feasible. Future transventricular chondroplastic laryngotomy clinical applications of the procedure are discussed including the resection of lesions and more complex reconstruction of vocal folds.
当前用于喉部暴露的手术技术存在明显局限性。为解决这些问题，本文描述了一种新颖的手术技术。我们的技术称为经室软骨成形喉切开术，可实现对喉内广泛且直接的外部入路。该手术过程在尸体和动物模型中均有描述。三只猪接受了甲状腺软骨开窗但未触及喉室，七只动物接受了完整手术，即打开甲状腺软骨窗并广泛打开喉室。术后20天处死动物。处死前，所有动物均接受喉镜检查，安乐死后，除组织学检查外，还对喉部和颈部区域进行大体检查。该手术通过喉室实现了同侧声带和对侧半喉的广泛暴露，从而能够对双侧前庭襞、喉室以及从前联合至杓状软骨进行双器械操作。未观察到术后并发症。通过甲状杓肌可轻松直接进入喉室。我们推测，对于暴露困难和/或传统手术器械不可行的患者，经室软骨成形喉切开术将成为首选的手术技术。本文还讨论了该手术未来在经室软骨成形喉切开术临床应用方面的情况，包括病变切除和更复杂的声带重建。
