Crumley R L
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange 92613-1491.
Ann Otol Rhinol Laryngol. 1993 Feb;102(2):81-4. doi: 10.1177/000348949310200201.
A review of our recent experience in patients with bilateral laryngeal paralysis is described. While we continue to use phrenic nerve transfers in patients with mobile arytenoids, patients with fixed arytenoids generally require some sort of vocal cord lateralization, either by arytenoidectomy and arytenoidopexy or by partial vocal cord resection. The endoscopic laser medial arytenoidectomy is a convenient and effective method for opening the posterior glottic airway. One arytenoid is reduced medially with the carbon dioxide laser. After about 3 months the opposite arytenoid can be treated similarly, if necessary. The procedure does not appear to affect arytenoid mobility, as the posterior commissure mucosa and underlying interarytenoid muscle are protected and hence unaffected by the procedure. Those patients with at least one mobile arytenoid cartilage are candidates for posterior cricoarytenoid muscle reinnervation. Although ansa cervicalis and phrenic nerve techniques have been described, the author has concentrated efforts on the phrenic nerve. This report describes the endoscopic laser medial arytenoidectomy procedure, while the phrenic nerve patients will be reported in a subsequent manuscript.
本文描述了我们近期对双侧喉麻痹患者的治疗经验。对于杓状软骨可活动的患者，我们继续采用膈神经移位术；而对于杓状软骨固定的患者，通常需要某种形式的声带外移术，可通过杓状软骨切除术和杓状软骨固定术，或部分声带切除术来实现。内镜激光内侧杓状软骨切除术是一种打开声门后气道的便捷有效方法。使用二氧化碳激光将一侧杓状软骨向内侧缩小。如有必要，约3个月后可对另一侧杓状软骨进行同样的治疗。该手术似乎不会影响杓状软骨的活动度，因为声门后联合黏膜及下方的杓间肌受到保护，因此未受该手术影响。那些至少有一个可活动杓状软骨的患者是环杓后肌再支配术的候选对象。虽然已经描述了颈袢和膈神经技术，但作者主要致力于膈神经研究。本报告描述了内镜激光内侧杓状软骨切除术，膈神经手术患者将在后续稿件中报告。
