Damazo Benjamin, Nanda Nainika, Dailey Seth
Division of Otolaryngology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
Laryngoscope. 2025 Apr;135(4):1460-1464. doi: 10.1002/lary.31890. Epub 2024 Nov 6.
Surgery for bilateral vocal fold immobility (BVFI) aims to establish a patent airway while maintaining voice and swallow function, a unique dilemma. Current techniques display unfavorable healing vectors, and exposed endolaryngeal tissue results in substantial airway granulation requiring postoperative care. We present a novel technique to improve glottic airway patency by preserving laryngeal mucosal lining and harnessing lateral retraction of glottic tissue to reduce revisions for granulation tissue and laryngeal scar.
Case-series analysis was performed on eight BVFI patients who underwent submucosal thyroarytenoid myectomy with arytenoidectomy for treatment from 2011 to 2021. Patient medical comorbidities and BVFI etiology were reviewed. Decannulation rates, revision procedures, requirement of emergency services, and pre- and postoperative status were assessed by laryngology and speech-language pathology using the following metrics: VHI, DI, Modified Medical Research Council (MMRC), GRBAS, jitter percentage, shimmer percentage, pitch range, maximum phonation time, and dysphonia severity index, and diet type. Pre- and postoperative distal-chip flexible laryngoscopy with stroboscopy was performed. Outcome measures were assessed using paired Student's t-test of pre- and postoperative categorical variables.
Successful decannulation was achieved in all (four of eight) patients with previous tracheostomy. All patients reported improved respiratory symptoms without tracheotomy. There was no difference in long-term voice outcomes. All patients tolerated a mechanical soft or regular diet, without new or worsened dysphagia.
Submucosal thyroarytenoid myomectomy with arytenoidectomy represents an effective BVFI treatment, through utilizing natural vectors of scarring, preservation of endolaryngeal mucosa, and preservation of the superficial lamina propria and the vocal ligament.
4 Laryngoscope, 135:1460-1464, 2025.
双侧声带麻痹（BVFI）手术旨在建立通畅气道，同时保留发声和吞咽功能，这是一个独特的难题。目前的技术显示出不良的愈合方向，喉内组织暴露会导致大量气道肉芽形成，需要术后护理。我们提出一种新技术，通过保留喉黏膜内衬并利用声门组织的侧向牵拉来改善声门气道通畅性，以减少肉芽组织和喉瘢痕的修复。
对2011年至2021年期间接受黏膜下甲杓肌切除术联合杓状软骨切除术治疗的8例BVFI患者进行病例系列分析。回顾患者的内科合并症和BVFI病因。由喉科学和言语病理学专业人员使用以下指标评估拔管率、修复手术、急诊服务需求以及术前和术后状况：嗓音障碍指数（VHI）、吞咽困难指数（DI）、改良医学研究委员会（MMRC）分级、GRBAS评分、抖动百分比、闪烁百分比、音调范围、最大发声时间、发音障碍严重程度指数以及饮食类型。术前行远端芯片可弯曲喉镜检查及频闪喉镜检查，术后进行同样检查。使用配对t检验评估术前和术后分类变量的结果指标。
所有曾行气管切开术的患者（8例中的4例）均成功拔管。所有患者均报告呼吸症状改善，无需气管切开。长期嗓音结果无差异。所有患者均能耐受机械软食或正常饮食，未出现新的吞咽困难或吞咽困难加重情况。
黏膜下甲杓肌切除术联合杓状软骨切除术是一种有效的BVFI治疗方法，其通过利用自然瘢痕形成方向、保留喉内黏膜、保留固有层浅层和声带韧带实现。
4 喉镜，135:1460 - 1464，2025年。
