Grundfast K M, Harley E
Department of Surgery, George Washington University School of Medicine, Washington, DC.
Otolaryngol Clin North Am. 1989 Jun;22(3):569-97.
The information presented in this article demonstrates that unilateral or bilateral vocal cord paresis or paralysis in infants and children is difficult to diagnose and difficult to manage. In an attempt to provide the otolaryngologist with a concise set of relevant guidelines, the following rules for management are presented here. 1. Suspect bilateral abductor vocal cord paralysis (BAVP) when a neonate or infant presents with high-pitched inspiratory stridor and evidence of airway compromise. Factors that should increase the suspicion of BAVP include associated Arnold-Chiari malformation; congenital anatomic abnormality involving the mediastinum (for example, tracheoesophageal fistula, vascular ring, other vascular anomalies); dysmorphic syndromes, especially those involving brainstem dysfunction; and manifest findings indicative of neuromuscular disorder. The neonate or infant with Arnold-Chiari malformation and inspiratory stridor has bilateral abductor vocal cord paralysis until proven otherwise. 2. Suspect unilateral vocal cord paresis or paralysis in an infant or child with hoarse voice, low-pitched cry, or breathy cry or voice. The infant who develops mild stridor and hoarse cry following surgical repair of a patent ductus arteriosus or tracheoesophageal fistula has a unilateral vocal cord paralysis until proven otherwise. 3. Direct laryngoscopy with the flexible fiberoptic nasopharyngolaryngoscope and photodocumentation using a videocassette recorder offers the best method for diagnosis of vocal cord paresis or paralysis. Additional diagnostic studies that may be helpful include radiographic studies, CT scan, MRI scan, electromyography of the larynx, and, in older children, stroboscopy. 4. In using a flexible direct laryngoscope be careful not to interpret all motions of the vocal cords or arytenoids as evidence to preclude the diagnosis of vocal cord paralysis or paresis and be careful not to mistake the anterior intraluminal portion of a normal cricoid for an "anterior glottic web." 5. Tracheotomy is often required in order to assure adequate airway during infancy for children with BAVP. However, with the advent of sophisticated cardiorespiratory monitoring equipment and methods for monitoring blood oxygen and carbon dioxide levels, tracheotomy can be delayed until attempts have been made to improve the adequacy of the airway with neurosurgical intervention or other procedures.(ABSTRACT TRUNCATED AT 400 WORDS)
本文所提供的信息表明，婴幼儿单侧或双侧声带麻痹很难诊断且难以处理。为了给耳鼻喉科医生提供一套简洁的相关指南，现给出以下处理规则。1. 当新生儿或婴儿出现高调吸气性喘鸣及气道受损迹象时，怀疑双侧声带外展麻痹（BAVP）。应增加对BAVP怀疑的因素包括相关的阿诺德 - 基亚里畸形；涉及纵隔的先天性解剖异常（例如，气管食管瘘、血管环、其他血管异常）；畸形综合征，尤其是那些涉及脑干功能障碍的；以及表明神经肌肉疾病的明显体征。患有阿诺德 - 基亚里畸形和吸气性喘鸣的新生儿或婴儿，在未被证明有其他情况之前，患有双侧声带外展麻痹。2. 当婴幼儿出现声音嘶哑、哭声低沉或带呼吸声的哭声或声音时，怀疑单侧声带麻痹。在动脉导管未闭或气管食管瘘手术修复后出现轻度喘鸣和声音嘶哑哭声的婴儿，在未被证明有其他情况之前，患有单侧声带麻痹。3. 使用可弯曲纤维鼻咽喉镜进行直接喉镜检查并使用盒式录像机进行图像记录，是诊断声带麻痹的最佳方法。其他可能有帮助的诊断研究包括放射学检查、CT扫描、MRI扫描、喉部肌电图，以及对大龄儿童进行频闪喉镜检查。4. 使用可弯曲直接喉镜时，要注意不要将声带或杓状软骨的所有运动都解释为排除声带麻痹或轻瘫诊断的证据，并且要注意不要将正常环状软骨的前腔内部分误认为是“前声门蹼”。5. 对于患有BAVP的儿童，为确保婴儿期气道通畅，通常需要进行气管切开术。然而，随着先进的心肺监测设备以及监测血氧和二氧化碳水平方法的出现，气管切开术可以推迟到尝试通过神经外科干预或其他程序改善气道通畅性之后。（摘要截选至400字）
