Newman M H, Work W P
Laryngoscope. 1976 Jun;86(6):840-9. doi: 10.1288/00005537-197606000-00010.
The spectrum of disabilities attendant to laryngeal paralysis range from mild hoarseness to complete upper airway obstruction depending upon the static position of the paralyzed cord or cords. The most distressing disabilities are those of bilateral vocal cord paralysis in which both vocal folds are fixed in the midline resulting in severe upper airway obstruction. Clearly the most acceptable solution to the problem of persistent laryngeal paralysis is through the establishment of normal neuromuscular integrity by vagal repair or neural transfer techniques. While electromyographic evidence of reinnervation and some restoration of cord motion has been described, synchronous neuromuscular activity is, at best, unpredictable and generally unsuccessful. Successful reinnervation procedures depend in part on early repair and herein lies a disparity between experimental work and its clinical applicability. Given the realities of delays in diagnosis and the unpredictability of operative reinnervation of the paralyzed larynx, we rely on alternative methods of improving the compromised glottic airway consequent to bilateral recurrent nerve paralysis of the larynx. During the period 1962 through 1974, 23 patients with complete bilateral paralysis of the larynx have been treated by the posterior extralaryngeal approach originally described by Woodman. The following is a description of the operative technique utilized with technical modifications which we consider important in enhancing operative results.
喉麻痹所伴随的残疾范围从轻度声音嘶哑到完全上呼吸道梗阻，这取决于麻痹声带的静态位置。最令人苦恼的残疾是双侧声带麻痹，即双侧声带固定于中线，导致严重的上呼吸道梗阻。显然，解决持续性喉麻痹问题最可接受的方法是通过迷走神经修复或神经移植技术来建立正常的神经肌肉完整性。虽然已经描述了再支配的肌电图证据和声带运动的一些恢复，但同步神经肌肉活动充其量是不可预测的，而且通常不成功。成功的再支配手术部分取决于早期修复，而这正是实验工作与其临床适用性之间的差距所在。鉴于喉麻痹诊断延迟的现实以及麻痹喉手术再支配的不可预测性，我们依靠替代方法来改善因双侧喉返神经麻痹导致的声门气道受损情况。在1962年至1974年期间，23例完全性双侧喉麻痹患者接受了最初由伍德曼描述的喉外后路手术治疗。以下是对所采用手术技术的描述，并进行了技术改进，我们认为这些改进对提高手术效果很重要。
