Teixido M T, Leonetti J P
Department of Otolaryngology, Head and Neck Surgery, Loyola University Medical Center, Maywood, IL 60153.
Otolaryngol Head Neck Surg. 1990 Feb;102(2):140-4. doi: 10.1177/019459989010200207.
The association of vocal cord dysfunction with thoracic aortic aneurysm (TAA) has been noted in the cardiovascular and otolaryngologic literature. A retrospective review of 168 cases of TAA was performed in order to: (1) define the natural history of associated recurrent laryngeal nerve paralysis (RLNP) and (2) propose mechanisms for the development of RLNP in operated and nonoperated aneurysms. Of 168 aneurysms, 5% manifested hoarseness secondary to RLNP. All had type I aneurysms. Only one patient regained vocal cord function after surgical treatment of the aneurysm. RLNP developed as a sequela of TAA repair in 12% of the patients managed surgically. RLNP associated with TAA type III repair had a higher incidence of recovery than paralysis that occurred after TAA type I repair (40% vs. 0% recovery). Sixty-six percent of all patients with permanently paralyzed larynges in this series attained glottic competence sufficient to avoid Teflon injection, and 27% of all RLNP associated with TAA in this series required Teflon injection for aspiration, severe dysphonia, or both. Seventeen percent of the patients with vocal cord paralysis associated with TAA recovered within 12 months. Aneurysm classification and pertinent anatomic relationships are discussed with reference to various mechanisms of recurrent laryngeal nerve paralysis.
心血管和耳鼻喉科文献中已注意到声带功能障碍与胸主动脉瘤（TAA）之间的关联。对168例胸主动脉瘤患者进行了回顾性研究，目的是：（1）明确相关喉返神经麻痹（RLNP）的自然病程，以及（2）提出手术和未手术的动脉瘤中喉返神经麻痹发生的机制。168例动脉瘤中，5%表现为继发于喉返神经麻痹的声音嘶哑。所有患者均为I型动脉瘤。动脉瘤手术治疗后，只有1例患者恢复了声带功能。在接受手术治疗的患者中，12%的患者喉返神经麻痹是胸主动脉瘤修复的后遗症。与III型胸主动脉瘤修复相关的喉返神经麻痹恢复率高于I型胸主动脉瘤修复后发生的麻痹（恢复率分别为40%和0%）。在该系列中，所有永久性喉麻痹患者中有66%获得了足以避免注射特氟龙的声门功能，该系列中与胸主动脉瘤相关的所有喉返神经麻痹患者中有27%因误吸、严重发音障碍或两者兼有而需要注射特氟龙。与胸主动脉瘤相关的声带麻痹患者中有17%在12个月内恢复。结合喉返神经麻痹的各种机制，讨论了动脉瘤的分类和相关解剖关系。
