Su Wan-Fu, Chen Chi-Jen, Huang Yun-Chen, Hsu Ying-Chieh, Ko Po-Yun, Liu Shao-Cheng
Department of Otolaryngology Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddist Tzu Chi Medical Foundation, Buddist Tzu Chi General Hospital, Taipei Branch, No. 289, Jianguo Rd., Xindian Dist., New Taipei City, 23142, Taiwan, Republic of China.
School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China.
Eur Arch Otorhinolaryngol. 2025 Jan;282(1):293-301. doi: 10.1007/s00405-024-08988-0. Epub 2024 Sep 24.
To stratify the severity of cricoarytenoid joint fixation (CAJF) by surgery and understand the role of it played in the bilateral vocal fold immobility (BVFI). The second objective emphasizes on the significance of the preoperative differential diagnosis from neurogenic immobility with medical history and endoscopic findings.
A retrospective review was conducted of 74 patients between 2005 and 2022. Careful medical history inquiry, and videolaryngoscopy are conducted to recruit the appropriate surgical candidates. All patients underwent arytenoid remobilization (AR) followed by vocal fold medialization with arytenoid adduction (AA) or lateralization with suture lateralization (SL). The severity of CAJF is graded during the operation or inferred based on the period from operation to recurrence.
A total of 18 patients, aged between 18 and 76 years, were analyzed. Among them, 14 cases were classified as the adducted type with ventilation problems, with three presenting with dyspnea, and 11 requiring artificial airways. Additionally, four patients presented with the abducted type, characterized by aphonia. Meanwhile, two additional cases were considered for comparison but were not included in this cohort of 18 subjects due to incorrect diagnosis and inappropriate management. Using AR procedure, the AA procedure offered three aphonia subjects a voiced sound without airway impairment and the SL procedure decannulated 100% (11/11) of the artificial airways and improved the airway patency in 100% (3/3) of the non-tracheostomized subjects despite the severity of CAJF. The severity of joint ankylosis was distributed as follows: In the aphonia group, there were three subjects with grade I, one subject with grade II, and 0 subjects with grade III. In the ventilation group, there was one subject with grade I, seven subjects with grade II, and six subjects with grade III. In contrast, the two cases used for comparison experienced recurrent dyspnea and failed decannulation because the AR procedure was not performed. The follow-up period was averaged in 58 and 14 months at least.
From this experience, it is the accurate preoperative diagnosis instead of the severity of CAJF that determines the successful rate in airway patency and voiced phonation if the AR procedure is utilized. Careful medical history inquiry and videolaryngoscopic examination can correctly differentiate the mechanical from neurogenic origin without the help of EMG. Evidence of level: 4.
通过手术对环杓关节固定（CAJF）的严重程度进行分层，并了解其在双侧声带麻痹（BVFI）中所起的作用。第二个目的强调根据病史和内镜检查结果对与神经源性麻痹进行术前鉴别诊断的重要性。
对2005年至2022年间的74例患者进行回顾性研究。通过仔细询问病史和进行电子喉镜检查来筛选合适的手术候选人。所有患者均接受了杓状软骨活动恢复术（AR），随后进行杓状软骨内收术（AA）使声带内移或缝线外侧化术（SL）使声带外移。在手术过程中对CAJF的严重程度进行分级，或根据手术至复发的时间进行推断。
共分析了18例年龄在18至76岁之间的患者。其中，14例被归类为内收型且存在通气问题，3例出现呼吸困难，11例需要人工气道。另外，4例为外展型，表现为失音。同时，另有2例被考虑用于比较，但由于诊断错误和处理不当未纳入这18例受试者队列。采用AR手术，AA手术使3例失音患者恢复发声且无气道损伤，SL手术使100%（11/11）的人工气道患者拔管，并使100%（3/3）未行气管切开术的患者气道通畅，尽管CAJF严重程度不同。关节强直的严重程度分布如下：在失音组中，I级有3例，II级有1例，III级有0例。在通气组中，I级有1例，II级有7例，III级有6例。相比之下，用于比较的2例患者出现反复呼吸困难且拔管失败，因为未进行AR手术。随访期平均至少为58个月和14个月。
根据这一经验，如果采用AR手术，决定气道通畅和发声成功率的是准确的术前诊断而非CAJF严重程度。仔细询问病史和进行电子喉镜检查可以在无需肌电图帮助的情况下正确区分机械性与神经源性病因。证据级别：4级。
