Ongkasuwan Julina, Courey Mark
Baylor College of Medicine, Texas Children's Hospital, TX, USA.
Curr Opin Otolaryngol Head Neck Surg. 2011 Dec;19(6):444-8. doi: 10.1097/MOO.0b013e32834c1e4f.
The management of a patient with bilateral vocal fold motion impairment (BVFMI) can be challenging for the otolaryngologist. The treatment traditionally involves tracheotomy, which can be very distressful for some patients. Alternatively, there are endoscopic procedures, which irreversibly sacrifice voice in order to improve airway. The optimal treatment of BVFMI still eludes us. The purpose of this review is to highlight an alternate management strategy for bilateral vocal fold paralysis using botulinum toxin (BTX). This procedure is predicated on the premise that vocal fold immobility is related to synkinetic reinnervation of the vocal fold. Eliminating any thyroarytenoid/lateral cricoarytenoid (LCA) activity during respiratory gestures should allow greater unopposed posterior cricoarytenoid abduction.
There have been several case reports and series, the largest of which involved 11 patients, describing the successful use of BTX for this application.
The best candidates for this adductor chemical denervation are those patients who have undergone trauma to the recurrent laryngeal nerve without evidence of cricoarytenoid joint fixation. Patients should have evidence of voluntary thyroarytenoid/LCA laryngeal electromyography activity, though true synkinesis cannot always be reliably identified. The procedure can be another management option for patients with BVFMI.
对于耳鼻喉科医生而言，双侧声带运动障碍（BVFMI）患者的管理颇具挑战性。传统治疗方法包括气管切开术，这对一些患者来说可能非常痛苦。另外，还有一些内镜手术，这些手术会不可逆地牺牲嗓音以改善气道。BVFMI的最佳治疗方法仍未明确。本综述的目的是强调一种使用肉毒杆菌毒素（BTX）治疗双侧声带麻痹的替代管理策略。该手术基于这样一个前提，即声带固定与声带的联动性再支配有关。在呼吸动作期间消除任何甲杓肌/环杓侧肌（LCA）活动应能使环杓后肌更大程度地无对抗外展。
已有多篇病例报告及系列研究，其中最大规模的研究涉及11例患者，描述了BTX在此应用中的成功使用情况。
这种内收肌化学去神经支配的最佳候选患者是那些喉返神经受过创伤且无环杓关节固定证据的患者。患者应具有甲杓肌/LCA喉肌电图活动的自主证据，尽管真正的联动性并不总是能可靠识别。该手术可为BVFMI患者提供另一种管理选择。
