Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University Saitama Medical Center, Saitama City, Saitama, Japan.
Am J Otolaryngol. 2012 May-Jun;33(3):303-7. doi: 10.1016/j.amjoto.2011.08.008. Epub 2011 Sep 29.
Laryngeal framework surgery is usually performed under local anesthesia but cannot be tolerated by some patients. To develop a new procedure for these patients, we evaluated voice outcomes after arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway (LMA) for unilateral vocal cord paralysis.
Eleven consecutive patients with severe unilateral vocal cord paralysis, with a maximum phonation time of less than 5 seconds, underwent arytenoid adduction combined with medialization laryngoplasty under general anesthesia using an LMA. Each paralyzed vocal cord was observed by intraoperative videolaryngoscopy. The vocal cord was moved to the position where the best vocal outcome could be expected, according to 3 parameters obtained from glottal images.
All patients achieved a maximum phonation time of more than 11 seconds. The mean airflow rate, which ranged from 550 to 1000 mL/s before surgery, improved to less than 390 mL/s. Perceptual evaluation using the grade, roughness, breathiness, asthenia and strain scale also improved significantly.
These results were equivalent to those of previous reports of surgeries performed under local anesthesia. Intraoperative endoscopic vocal cord observation through the LMA may have contributed to the positive results.
喉框架手术通常在局部麻醉下进行，但有些患者无法耐受。为了为这些患者开发一种新的程序，我们评估了在全身麻醉下使用喉罩气道 (LMA) 进行杓状软骨内收和声带内侧成形术治疗单侧声带麻痹的嗓音结果。
11 例连续单侧声带麻痹患者，最大发音时间少于 5 秒，在全身麻醉下使用 LMA 进行杓状软骨内收和声带内侧成形术。术中通过视频喉镜观察每一侧麻痹声带。根据声门图像获得的 3 个参数，将声带移动到可以获得最佳嗓音效果的位置。
所有患者的最大发音时间均超过 11 秒。术前气流率范围为 550 至 1000 毫升/秒，改善至低于 390 毫升/秒。使用等级、粗糙度、呼吸声、无力和紧张度量表进行的感知评估也显著改善。
这些结果与局部麻醉下手术的先前报告结果相当。通过 LMA 进行的术中内镜声带观察可能有助于取得积极的结果。
