Weed D T, Jewett B S, Rainey C, Zealear D L, Stone R E, Ossoff R H, Netterville J L
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Ann Otol Rhinol Laryngol. 1996 Aug;105(8):592-601. doi: 10.1177/000348949610500802.
Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after previous recurrent laryngeal nerve section (RLNS) are presented in 2 of these 18 patients. We introduced RLNA as a modification of standard RLNS to prevent neural regrowth to the hemiparalyzed larynx and subsequent recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Resolution of symptoms was determined by routine follow-up assessment, perceptual voice analysis, and patient self-assessment. Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determined at routine follow-up. Two of the 16 later developed spasms after medialization laryngoplasty for treatment of weak voice persistent after the avulsion. This yielded a total of 14 of 18, or 78%, who were unanimously judged by four speech pathologists to have no recurrence of SD at the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spasms. Three of 18 patients presented with recurrent SD after previous RLNS. At the time of subsequent RLNA, each patient had evidence of neural regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 years after revision avulsion but developed spasms after medialization laryngoplasty, and the final patient developed spasms 3.75 years after revision RLNA. Medialization laryngoplasty with Silastic silicone rubber was performed in 6 of 18, with correction of postoperative breathiness in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 of these with downsizing of the implant. We conclude that RLNA represents a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.
报告了18例因内收肌痉挛性发声障碍（SD）接受喉返神经撕脱术（RLNA）患者的3至7年长期随访情况。这18例患者中有2例提供了既往喉返神经切断术（RLNS）后神经再生的数据。我们引入RLNA作为标准RLNS的改良术式，以防止神经再生至半麻痹喉部并避免SD复发。我们共对22例患者实施了RLNA，现报告其中18例患者的3至7年随访情况。通过常规随访评估、嗓音感知分析和患者自我评估来确定症状缓解情况。在RLNA术后3年进行常规随访时，18例中有16例（89%）未出现痉挛复发。这16例中有2例在为治疗撕脱术后持续存在的嗓音无力而进行喉内移术成形术后出现了痉挛。在3至7年的较长随访期内，18例中有14例（78%）经4名言语病理学家一致判定无SD复发。这4例患者中有2例被所有4名分析人员判定存在频繁、短暂的痉挛。另外2例被4名分析人员中的2名判定为偶尔、短暂的痉挛。18例患者中有3例在既往RLNS后出现了SD复发。在后续实施RLNA时，通过术中肌电图和远端神经残端组织学评估，每例患者的远端神经残端均有神经再生的证据。1例患者在RLNA后未再出现SD，1例在再次撕脱术后4年未出现痉挛，但在喉内移术成形术后出现了痉挛，最后1例患者在再次RLNA术后3.75年出现了痉挛。18例中有6例进行了硅胶喉内移术成形术，所有6例术后呼吸音粗糙的情况均得到纠正，但3例出现了痉挛复发。其中1例通过减小植入物尺寸后痉挛得到缓解。我们得出结论，对于不耐受肉毒杆菌毒素注射的SD患者，RLNA是一种有效的治疗方法。
