Dejonckere P H
Institut de Phoniatrie, Université d'Utrecht, Pays-Bas.
Folia Phoniatr (Basel). 1993;45(5):209-13.
From a clinical point of view, unilateral vocal fold paresis means that one of the vocal folds shows reduced mobility. Etiology may be mechanical or supranuclear, but in most cases it is a partial peripheral neurogenic lesion in the muscles innervated by one of the recurrent laryngeal nerves. On the one hand, a retrospective analysis was made of 71 cases with laryngoscopically reduced mobility of one vocal fold: 58 patients had electromyographic signs of partial denervation; 13 had normal electromyographic activity. Possible explanations are mechanical factors, paradoxical reinnervation, or central neurological pathology. On the other hand we reviewed 179 cases with an electromyographic diagnosis of unilateral partial peripheral neurogenic lesion in the muscles innervated by one of the recurrent laryngeal nerves: 119 patients showed a clinically immobile vocal fold, 2 a normally moving vocal fold and 58 a paretic vocal fold. A lot of immobile vocal folds are thus partial denervations. Insufficient amount of functional motor units and paradoxical reinnervation provide possible explanations.
从临床角度来看，单侧声带麻痹意味着一侧声带活动度降低。病因可能是机械性的或核上性的，但在大多数情况下，它是由一侧喉返神经支配的肌肉中的部分周围神经源性病变。一方面，对71例喉镜检查显示一侧声带活动度降低的病例进行了回顾性分析：58例患者有部分失神经的肌电图表现；13例肌电图活动正常。可能的解释是机械因素、矛盾性再支配或中枢神经病理学。另一方面，我们回顾了179例经肌电图诊断为一侧喉返神经支配的肌肉存在单侧部分周围神经源性病变的病例：119例患者表现为临床上声带固定不动，2例声带活动正常，58例声带麻痹。因此，许多固定不动的声带是部分失神经的。功能性运动单位数量不足和矛盾性再支配提供了可能的解释。
