Crumley R L
Department of Surgery, University of California, Irvine.
Ann Otol Rhinol Laryngol. 1989 Feb;98(2):87-92. doi: 10.1177/000348948909800201.
Basic research and surgical cases have shown that the injured recurrent laryngeal nerve (RLN) may regenerate axons to the larynx that inappropriately innervate both vocal cord adductors and abductors. Innervation of vocal cord adductor muscles by those axons that depolarize during inspiration is particularly devastating to laryngeal function, since it produces medial vocal cord movement during inspiration. Many patients thought to have clinical bilateral vocal cord paralysis can be found to have synkinesis on at least one side. This will make the glottic airway smaller, particularly during inspiration, than would true paralysis of all the intrinsic laryngeal muscles. Patients with bilateral vocal cord paralysis should undergo laryngeal electromyography. If inspiratory innervation of the adductor muscles is present, simple reinnervation of the posterior cricoarytenoid muscle will fail. The adductor muscles also must be denervated by transection of the adductor division of the regenerated RLN.
基础研究和外科病例表明，受损的喉返神经（RLN）可能会向喉部再生轴突，这些轴突会不恰当地支配声带内收肌和外展肌。在吸气时去极化的那些轴突对声带内收肌的支配对喉功能尤其具有破坏性，因为它会在吸气时导致声带向内侧移动。许多被认为患有临床双侧声带麻痹的患者至少在一侧会出现联动。这将使声门气道变小，尤其是在吸气时，比所有喉内肌真正麻痹时还要小。双侧声带麻痹患者应接受喉肌电图检查。如果存在内收肌的吸气性神经支配，单纯对环杓后肌进行再神经支配将会失败。还必须通过切断再生喉返神经的内收肌分支来使内收肌失神经支配。
