Prasad Vyas M N, Remacle Marc
Singapore Medical Specialist Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,
Department of Otolaryngology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg.
Adv Otorhinolaryngol. 2020;85:85-97. doi: 10.1159/000456686. Epub 2020 Nov 9.
Vocal fold immobility can be either unilateral or bilateral and partial or complete. The aim of this chapter is to discuss the management of unilateral paresis using medialization thyroplasty with or without arytenoid adduction as a means of treating neurogenic causes as opposed to mechanical fixation. Medialization thyroplasty is an open surgical procedure that is performed under local or general anesthesia. Essentially, it aims to close the glottic gap, approximating both vocal folds together and thereby allowing for restoration of the efficiency of the larynx. The glottic gap results from atrophy of the affected vocal fold and in so doing results in glottic insufficiency which causes voice breathiness, strain, fatigue, aspiration, and swallowing difficulties that make up the bulk of symptoms associated with this condition. Unlike injection laryngoplasty, medialization thyroplasty does not increase the "bulk" of the atrophic vocal fold but merely brings the fold closer to its unaffected partner. Besides the obvious lateralization, there is occasionally a third dimensional component to the affected fold. The slipping and prolapse forward of the arytenoid cartilage due to atrophy of the muscles supporting it and the natural declination of the facet joint it rests on cause a vertical drop of the level of the affected vocal fold that may not be remedied with the medialization procedure, hence requiring arytenoid adduction. Although attempts to medialize the vocal fold have been described in the past with limited access, the basic premise of creating a window in the thyroid cartilage remains central. The differences between materials used, their respective strengths and weaknesses, the pitfalls and pearls in achieving a good closure and improvement in voice, swallow, and safety of the airway are all discussed accordingly.
声带固定可分为单侧或双侧，部分固定或完全固定。本章的目的是讨论使用甲状软骨成形术加或不加杓状软骨内收术来治疗神经源性原因导致的单侧声带麻痹的处理方法，而非机械固定。甲状软骨成形术是一种在局部或全身麻醉下进行的开放性手术。本质上，它旨在闭合声门间隙，使两侧声带靠近，从而恢复喉部的功能效率。声门间隙是由患侧声带萎缩引起的，进而导致声门功能不全，引起声音粗糙、紧张、疲劳、误吸和吞咽困难，这些构成了与该病症相关的主要症状。与注射喉成形术不同，甲状软骨成形术不会增加萎缩声带的“体积”，而只是使该声带更靠近未受影响的对侧声带。除了明显的侧移外，患侧声带偶尔还存在三维变化。由于支撑杓状软骨的肌肉萎缩以及杓状软骨所依托的关节面自然倾斜，导致杓状软骨向前滑动和脱垂，使患侧声带水平垂直下降，这可能无法通过甲状软骨成形术得到纠正，因此需要进行杓状软骨内收术。尽管过去曾描述过在有限入路情况下尝试使声带内移，但在甲状软骨上开窗的基本前提仍然是核心。相应地，还将讨论所用材料之间的差异、它们各自的优缺点、实现良好闭合以及改善声音、吞咽和气道安全性方面的陷阱与要点。
