Netterville J L, Coleman J R, Chang S, Rainey C L, Reinisch L, Ossoff R H
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2559, USA.
Ann Otol Rhinol Laryngol. 1998 Sep;107(9 Pt 1):735-44. doi: 10.1177/000348949810700901.
Teflon injection has been used for vocal fold medialization following paralysis. Recently, numerous articles have discussed the complications of Teflon injection, including overinjection, airway obstruction. Teflon granuloma, and an abnormal mass effect creating a decreased vibratory character of the true vocal fold. Multiple techniques for Teflon removal have been described. This report details our experience with complete Teflon granuloma removal via a lateral laryngotomy under local anesthesia. Microscopic dissection of the entire granuloma and the paraglottic space was accomplished in all patients. Due to extensive destruction caused by the granuloma, the vocal ligament was resected in 3 patients; it was partially resected and reanastomosed in 1 case, and spared in 6 patients. Laryngeal reconstruction was accomplished with an inferiorly based sternohyoid muscle rotation flap and arytenoid adduction. Effortful speech secondary to pressed vocal quality resolved in all patients. Near-normal to normal vocal quality was obtained in 4 patients, with the average "voice desirability" improving 60% and the effective glottic width increasing 29%. Factors that contributed to a successful outcome included noninvolvement of the vocal ligament and sparing of the mucosal cover.
聚四氟乙烯注射已被用于麻痹后的声带内移。最近，许多文章讨论了聚四氟乙烯注射的并发症，包括注射过量、气道阻塞、聚四氟乙烯肉芽肿以及异常的肿块效应导致真声带振动特性降低。已经描述了多种聚四氟乙烯清除技术。本报告详细介绍了我们在局部麻醉下通过外侧喉切开术完全清除聚四氟乙烯肉芽肿的经验。所有患者均完成了整个肉芽肿和声门旁间隙的显微解剖。由于肉芽肿造成的广泛破坏，3例患者切除了声带韧带；1例患者部分切除并重新吻合，6例患者保留了声带韧带。采用低位胸骨舌骨肌旋转皮瓣和杓状软骨内收进行喉重建。所有患者因声带受压导致的费力发声均得到缓解。4例患者获得了接近正常到正常的嗓音质量，平均“嗓音满意度”提高了60%，有效声门宽度增加了29%。促成成功结果的因素包括声带韧带未受累和黏膜覆盖得以保留。
