Department of Otolaryngology, Toho University Omori Medical Center, 6-11-1, Omorinishi, Otaku 143-8541, Tokyo, Japan.
Department of Otolaryngology-Head and Neck Surgery, Yokohama City University School of Medicine, Kanagawa, Japan.
Auris Nasus Larynx. 2020 Aug;47(4):624-631. doi: 10.1016/j.anl.2020.02.005. Epub 2020 Feb 26.
To present the clinical findings of 10 cases of bilateral vocal fold immobility (adducted type) and suggest potential treatment options.
This retrospective study included 10 patients who underwent tracheostomy for restricted airway due to bilateral vocal fold immobility of the adducted type during the period from 2007 to 2017. All 10 patients underwent unilateral laterofixation surgery with or without additional arytenoidectomy using a CO laser. The effect of laterofixation surgery for decannulation was evaluated. Statistical analysis was performed to assess the effects of laterofixation based on the results of preoperative and intraoperative examinations including endoscopic examinations, electromyography, and the intraoperative traction-mobility test.
Initial laterofixation surgery for decannulation was effective in 6 cases. In the 4 cases that exhibited laterofixation failure, additional endoscopic subtotal arytenoidectomy was performed. Statistical analysis of the effects of laterofixation revealed that, in cases with bilateral preserved muscle tone, unilateral simple laterofixation surgery was unable to achieve a significantly effective glottal airway. Additional subtotal arytenoidectomy was also ineffective in a case with bilateral ankylosis.
Based on the clinical findings in these 10 cases of bilateral vocal fold immobility of the adducted type, treatment options are suggested and a severity classification system of bilateral vocal fold immobility is proposed that focuses mainly on electromyography results for assessment of dynamic restenosis and traction-mobility test results for assessment of static restenosis. Validation of the classification system is needed in a larger cohort of cases of bilateral vocal fold immobility.
介绍 10 例双侧声带固定（内收型）的临床发现，并提出潜在的治疗选择。
本回顾性研究纳入了 2007 年至 2017 年间因双侧声带内收型固定导致气道受限而行气管切开术的 10 例患者。所有 10 例患者均采用 CO2 激光行单侧外侧固定术，或联合或不联合杓状软骨切除术。评估外侧固定术对拔管的效果。基于术前和术中检查（包括内镜检查、肌电图和术中牵引-移动试验）的结果，进行统计分析，评估外侧固定术的效果。
6 例患者初次行外侧固定术以实现拔管，效果良好。4 例外侧固定术失败的患者行进一步的内镜下杓状软骨次全切除术。外侧固定术效果的统计分析表明，双侧肌肉张力保留的患者中，单侧单纯外侧固定术无法有效实现声门气道。双侧粘连的患者行进一步的杓状软骨次全切除术也无效。
根据这 10 例双侧声带内收型固定的临床发现，提出了治疗选择，并提出了一个主要基于肌电图结果评估动态再狭窄和基于牵引-移动试验结果评估静态再狭窄的双侧声带固定严重程度分类系统。需要在更大的双侧声带固定病例队列中验证该分类系统。
