Department of Otolaryngology Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddist Tzu Chi Medical Foundation, New Taipei City, School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China.
Department of Otolaryngology-Head and Neck Surgery Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
J Voice. 2023 Sep;37(5):800.e7-800.e15. doi: 10.1016/j.jvoice.2021.02.019. Epub 2021 Mar 19.
In order to correct the varying vocal fold positions to meet the various clinical requirements in patients with bilateral vocal fold immobility, we present pertinent surgical methods to treat them.
From 2005 to 2020, 115 patients diagnosed with bilateral vocal fold immobility were addressed for ventilation in 89 patients and for phonation in 26 patients. In the ventilation surgery group, all the neurogenic subjects received mere suture lateralization (SL) procedures and the mechanical ones underwent arytenoid release (AR) plus SL procedures if the cricoarytenoid joint fixation (CAJF) could be confirmed before operation. In the phonation group, neurogenic subjects received nonsurgical treatment and the mechanical ones underwent AR plus arytenoid adduction (AA) procedure. The decannulation rate and respiratory comfort rate for each subgroup will be calculated and the phonatory tests were conducted.
In the ventilation group, 55% (49/89) of subjects received related surgeries. Mere SL offered 40 successful decannulation or respiratory comfort in 42 neurogenic subjects (95.2%). The single episode rate was high as 95%. An AR plus SL procedure also obtained 100% of decannulation or respiratory comfort with a single episode of surgical procedure if the CAJF could be confirmed preoperatively. In the phonation group, 15% (4/26) of subjects received appropriate surgeries. Single AR plus AA procedures also led to 100% (4/4) of the appropriate candidates serviceable sound.
SL procedure keeping intact laryngeal mucosa usually offered permanent glottis enlarging effect or decannulation with a single episode of procedure. The use of arytenoid release for CAJF has led to remarkable advances in the ultimate surgical outcomes of both the ventilation and phonation in terms of decreasing revision surgeries.
level 4.
为了纠正各种声带位置，以满足双侧声带固定患者的各种临床需求，我们提出了相关的手术方法来治疗这些患者。
2005 年至 2020 年，我们共诊治了 115 例双侧声带固定患者，其中 89 例患者为通气问题，26 例患者为发音问题。在通气手术组中，所有神经性患者仅行声带侧位术（SL），如果术前可明确环杓关节固定（CAJF），则机械性患者行杓状软骨松解术（AR）+SL。在发音组中，神经性患者行非手术治疗，机械性患者行 AR+杓状软骨内收术（AA）。将计算每个亚组的拔管率和呼吸舒适度率，并进行发音测试。
通气组中，55%（49/89）的患者接受了相关手术。单纯 SL 使 42 例神经性患者中的 40 例（95.2%）成功拔管或呼吸舒适。单次发作率高达 95%。如果术前可明确 CAJF，行 AR+SL 手术也可 100%获得拔管或呼吸舒适，且仅需单次手术。在发音组中，15%（4/26）的患者接受了适当的手术。单纯 AR+AA 手术也使 100%（4/4）的合适患者获得了可接受的声音。
保留喉黏膜的 SL 手术通常可提供永久性的声带扩大效果或单次手术即可拔管。对于 CAJF 的杓状软骨松解术的应用，在减少手术次数的前提下，无论是通气还是发音，都显著提高了最终手术效果。
4 级。
