Cleveland Clinic, Head and Neck Institute, Cleveland, OH, USA.
Am J Otolaryngol. 2019 May-Jun;40(3):462-464. doi: 10.1016/j.amjoto.2019.03.018. Epub 2019 Mar 27.
Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula.
Case report.
A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability. The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression.
Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.
声带内侧移位术是治疗单侧声带麻痹患者的一种常见的嗓音康复方法。并发症并不常见，植入物延迟感染也很少见。我们报告了一例动物抓伤后导致的延迟感染性并发症，导致喉皮瘘。
病例报告。
一位 73 岁女性因特发性单侧声带麻痹接受了硅胶植入物的成功和无并发症的声带内侧移位术。手术后一年多，她在前颈部被动物抓伤后出现感染，颈部 CT 显示左斜方肌脓肿。切开引流后，培养出耐甲氧西林金黄色葡萄球菌。尽管进行了针对培养的抗生素治疗，但颈部仍持续渗出。喉镜和频闪喉镜检查显示声带内侧移位，无明显肉芽组织，黏膜柔韧性正常。患者接受了颈部探查，发现喉皮瘘。因此，瘘管和植入物均被移除。用斜方肌前进步入声带成形窗来关闭伤口。术后 1 个月，患者继续接受抗生素治疗，无颈部感染复发迹象，伤口愈合良好，频闪喉镜检查显示完全声门闭合、声带对称振动，发音可接受，仅轻度声门上压迫。
声带内侧移位术的迟发性并发症很少见。本例表明，动物抓伤后会导致喉内植入物延迟感染，需要取出植入物、局部组织重建，并进行针对培养的抗生素治疗。
