Ossoff R H, Koriwchak M J, Netterville J L, Duncavage J A
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232-2559.
Ann Otol Rhinol Laryngol. 1993 Jun;102(6):405-12. doi: 10.1177/000348949310200601.
The difficulties in treating granulomas resulting from Teflon injection into the vocal fold are underreported in the literature. We have reviewed our experience with nine patients undergoing 27 procedures for Teflon granuloma. Two patients required tracheotomy before undergoing endoscopic granuloma removal because of airway compromise, and a third required urgent tracheotomy following endoscopy. One of the patients requiring elective tracheotomy had a granuloma that extended across the midline to the contralateral arytenoid, causing its fixation. Arytenoidectomy was required for decannulation in this patient. In all but one patient the granuloma nearly completely replaced the thyroarytenoid muscle. This extensive involvement often precludes the adequate excision of the granuloma in a single procedure; however, the microflap technique allows mucosal preservation to facilitate future procedures. In some cases the granuloma destroys large amounts of mucosa, and a microflap cannot be elevated and saved. The difficulties of excision are related to the near-total replacement of the thyroarytenoid muscle by granuloma. This paper will help the otolaryngologist--head and neck surgeon understand this destructive process and the resulting difficulties in surgical rehabilitation.
文献中对聚四氟乙烯注射至声带所致肉芽肿的治疗困难报道不足。我们回顾了9例患者接受27次聚四氟乙烯肉芽肿手术的经验。2例患者因气道受压在接受内镜下肉芽肿切除术前需要气管切开，第3例患者在内镜检查后需要紧急气管切开。其中1例需要择期气管切开的患者，其肉芽肿延伸至中线对侧杓状软骨，导致其固定。该患者拔管需要行杓状软骨切除术。除1例患者外，所有患者的肉芽肿几乎完全取代了甲杓肌。这种广泛累及常常使得在单次手术中无法充分切除肉芽肿；然而，微型皮瓣技术可保留黏膜，便于未来手术。在某些情况下，肉芽肿会破坏大量黏膜，无法掀起并保留微型皮瓣。切除的困难与肉芽肿几乎完全取代甲杓肌有关。本文将帮助耳鼻咽喉头颈外科医生了解这一破坏性过程以及由此导致的手术修复困难。
