Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan; Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Surgery. 2020 Oct;168(4):578-585. doi: 10.1016/j.surg.2020.04.042. Epub 2020 Jun 28.
Iatrogenic unilateral vocal fold paralysis caused by thyroid surgery induces profound physical and psychosocial distress in patients. The natural course of functional recovery over time differs substantially across subjects, but the mechanisms underlying this difference remain unclear. In this study, we examined whether the anatomic site of the lesion affected the trajectory of recovery.
In this prospective case series study in a single medical center, patients with thyroid surgery-related unilateral vocal fold paralysis were evaluated using quantitative laryngeal electromyography, videolaryngostroboscopy, voice acoustic analysis, the Voice Outcome Survey, and the Short Form-36 quality-of-life questionnaire. Patients with and without superior laryngeal nerve injuries were compared.
Forty-two patients were recruited, among whom 15 and 27 were assigned to the with and without superior laryngeal nerve injury groups, respectively. Compared with the group without superior laryngeal nerve injury, the group with superior laryngeal nerve injury group demonstrated less improvement in the recruitment of vocal fold adductors, and the group also had more severe impairment of vocal fold vibration, maximum phonation time, jitter, shimmer, and harmony-to-noise ratio at the first evaluation. This difference was also found in the glottal gap and maximum phonation time 12 months after the injury.
Among patients with thyroid surgery-related unilateral vocal fold paralysis, superior laryngeal nerve injury induces a distinctively different recovery trajectory compared with those without superior laryngeal nerve injury characterized by less reinnervation of vocal fold adductors and worse presentation in terms of the glottal gap and maximum phonation time. This study emphasizes the importance of superior laryngeal nerve function and its preservation in thyroid surgery.
甲状腺手术后的医源性单侧声带麻痹会给患者带来严重的身体和心理困扰。不同患者的功能恢复自然进程存在显著差异，但导致这种差异的机制尚不清楚。本研究旨在探讨病变的解剖部位是否会影响恢复的轨迹。
本研究为单中心前瞻性病例系列研究，对甲状腺手术相关单侧声带麻痹患者进行定量喉肌电图、频闪喉镜、嗓音声学分析、嗓音结果调查和健康调查简表 36 项（Short Form-36）生活质量问卷评估。比较伴有和不伴有喉上神经损伤的患者。
共纳入 42 例患者，其中 15 例和 27 例分别被分配到伴有和不伴有喉上神经损伤组。与不伴有喉上神经损伤组相比，伴有喉上神经损伤组声带内收肌的募集能力改善较小，声带振动、最长发声时间、基频微扰、振幅微扰和谐噪比在首次评估时也更严重受损。这种差异在损伤后 12 个月时的声门裂和最长发声时间上仍然存在。
在甲状腺手术相关单侧声带麻痹患者中，喉上神经损伤导致的恢复轨迹与不伴有喉上神经损伤的患者明显不同，表现为声带内收肌的再神经支配较少，声门裂和最长发声时间的表现更差。本研究强调了喉上神经功能及其在甲状腺手术中的保护的重要性。
