Hoffman Henry T, Heaford Andrew C, Dailey Seth H, Bock Jonathan M, Van Daele Douglas J, Ahlrichs-Hanson Jan S, Quebbemann Greg J, Johnson Micaela N, Boltz Justin E, Tiedt Sean L
The Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA.
Ann Otol Rhinol Laryngol. 2014 Mar;123(3):195-205. doi: 10.1177/0003489414522968.
We report development of a device and technique to manage laryngeal paralysis through minimal-access arytenoid adduction (for unilateral paralysis) and arytenoid abduction (for bilateral paralysis).
A human cadaver study coupled with directed engineering was used to develop instrumentation designed to secure the muscular process of the arytenoid into favorable adducted or abducted positions. Digital video, photography, and 3-dimensional computed tomographic (CT) imaging of cadaveric larynges were done to evaluate the surgical technique.
Testing of prototypes identified the ideal implant to be a 0.36-mm wire with a distal spring-wound coil placed through a trocar via a small drill hole in the anterior thyroid cartilage. An endoscopic view of transilluminated light through the pyriform sinus mucosa identified the tip location of the trocar adjacent to the muscular process of the arytenoid cartilage. Placement of the device through the trocar permitted rotation to engage the muscular process and/or adjacent soft tissue with the distal coil. Implant fixation to the thyroid cartilage positioned the vocal cord into either adduction or abduction. Three-dimensional CT imaging coupled with review of the video documentation established the feasibility of this technique.
We confirm the feasibility of minimal-access arytenoid adduction and abduction through development of a new technique and device.
我们报告一种通过微创杓状软骨内收（用于单侧麻痹）和杓状软骨外展（用于双侧麻痹）来管理喉麻痹的设备和技术的开发情况。
采用人体尸体研究结合定向工程技术来开发用于将杓状软骨的肌突固定到有利的内收或外展位的器械。对尸体喉部进行数字视频、摄影和三维计算机断层扫描（CT）成像，以评估手术技术。
对原型进行测试后确定理想的植入物是一根0.36毫米的金属丝，其远端带有弹簧缠绕线圈，通过甲状腺软骨前的一个小钻孔经套管针置入。通过梨状窦黏膜的透照光的内镜视图可确定套管针尖端位于杓状软骨肌突附近的位置。通过套管针放置该设备可使其旋转，从而使远端线圈与肌突和/或相邻软组织接合。将植入物固定到甲状腺软骨上可使声带处于内收或外展位置。三维CT成像结合视频记录的回顾证实了该技术的可行性。
通过开发一种新技术和设备，我们证实了微创杓状软骨内收和外展的可行性。
