Netterville J L, Koriwchak M J, Winkle M, Courey M S, Ossoff R H
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Ann Otol Rhinol Laryngol. 1996 Feb;105(2):85-91. doi: 10.1177/000348949610500201.
The anterior cervical approach is commonly used for access to the cervical spine. Vocal fold paralysis (VFP), a complication of this approach, is underrepresented in the literature. A review of the database of the Vanderbilt Voice Center revealed 289 patients with VFP, including 16 patients who developed paralysis as a result of an anterior cervical approach. The paralysis was on the right side in all but 1 patient. Compared to patients who developed VFP after thyroidectomy and carotid endarterectomy, patients with VFP after an anterior cervical approach have a higher incidence of aspiration and dysphagia, suggesting the presence of trauma to the superior laryngeal and pharyngeal branches as well as the recurrent branch of the vagus nerve. Two patients had partial return and 1 patient had complete return of vocal fold movement within 10 months. Of the remaining 13 patients, 8 underwent vocal fold medialization with improvement of symptoms. Two patients are 6 and 7 months postinjury and await vocal fold medialization. Two patients are 27 months and 45 months postinjury and are considering vocal fold medialization. The remaining patient was lost to follow-up. An anatomic-geometric analysis of the right and left recurrent laryngeal nerves was performed by using measurements obtained from computed tomography scans of 8 patients with idiopathic unilateral VFP, as well as experience gained through surgical and cadaveric dissections. We conclude 1) the anterior cervical approach may place multiple branches of the vagus nerve at risk; 2) because of anatomic-geometric factors, the right-sided anterior cervical approach may carry a greater risk to the ipsilateral recurrent laryngeal nerve than does the left; and 3) an understanding of the anatomy and geometry presented herein allows relatively safe exposure from either side of the neck.
颈椎前路手术常用于进入颈椎。声带麻痹（VFP）是该手术的一种并发症，但在文献中的报道较少。对范德比尔特嗓音中心数据库的回顾显示，有289例VFP患者，其中16例是由于颈椎前路手术导致的麻痹。除1例患者外，其余患者的麻痹均发生在右侧。与甲状腺切除术后和颈动脉内膜切除术后发生VFP的患者相比，颈椎前路手术后发生VFP的患者出现误吸和吞咽困难的发生率更高，这表明喉上神经和咽支以及迷走神经的喉返支受到了损伤。2例患者在10个月内声带运动部分恢复，1例患者完全恢复。其余13例患者中，8例行声带内移术，症状改善。2例患者分别在受伤后6个月和7个月，等待声带内移术。2例患者分别在受伤后27个月和45个月，正在考虑声带内移术。其余1例患者失访。通过对8例特发性单侧VFP患者的计算机断层扫描测量结果，以及手术和尸体解剖获得的经验，对左右喉返神经进行了解剖几何分析。我们得出以下结论：1）颈椎前路手术可能使迷走神经的多个分支处于危险之中；2）由于解剖几何因素，右侧颈椎前路手术对同侧喉返神经的风险可能比左侧更大；3）了解本文介绍的解剖结构和几何形状，可使颈部两侧的暴露相对安全。
