Friedman M, Toriumi D M
Department of Otolaryngology-Head and Neck Surgery, University of Illinois College of Medicine, Chicago.
Arch Otolaryngol Head Neck Surg. 1989 Jan;115(1):95-8. doi: 10.1001/archotol.1989.01860250097035.
Hoarseness after endotracheal intubation can result from compression of the anterior branch of the recurrent laryngeal nerve as it passes behind the thyroid cartilage to innervate the lateral cricoarytenoid muscle. This usually occurs when the cuff of the endotracheal tube lies in the larynx instead of the trachea. When a nasogastric tube is positioned in the midline, resultant postcricoid inflammation can result in vocal cord immobility. This may result from neuropraxia of the posterior branch of the recurrent laryngeal nerve that innervates the posterior cricoarytenoid and interarytenoid muscles, or inflammatory spasm of the interarytenoid muscles themselves. We present a case of vocal cord paralysis after general anesthesia that may have been caused by an esophageal stethoscope. The mechanism for vocal cord immobility could be similar to that of a midline nasogastric tube with resultant postcricoid inflammation. We describe measures that can be taken to prevent vocal cord paralysis after intubation of the larynx or esophagus.
气管插管后声音嘶哑可能是由于喉返神经前支在穿过甲状软骨后方支配环杓侧肌时受到压迫所致。这种情况通常发生在气管导管的套囊位于喉部而非气管内时。当鼻胃管置于中线位置时，由此导致的环状软骨后炎症可引起声带固定。这可能是由于支配环杓后肌和杓间肌的喉返神经后支发生神经失用，或者是杓间肌本身的炎性痉挛所致。我们报告一例全身麻醉后声带麻痹的病例，可能是由食管听诊器引起的。声带固定的机制可能与中线鼻胃管导致环状软骨后炎症的机制相似。我们描述了在喉或食管插管后可采取的预防声带麻痹的措施。
