Manski T J, Wood M D, Dunsker S B
Department of Otolaryngology, The Christ Hospital, University of Cincinnati College of Medicine, Ohio 45219, USA.
J Neurosurg. 1998 Nov;89(5):839-43. doi: 10.3171/jns.1998.89.5.0839.
The authors report a rare case of bilateral vocal cord paralysis following anterior cervical discectomy and fusion (ACD/F) in a patient who had a preexisting, clinically silent, and unrecognized unilateral vocal cord paralysis from a remote cardiac surgical procedure. The patient, a 41-year-old woman who developed acute respiratory stridor and respiratory insufficiency at the time of extubation after undergoing a C6-7 ACD/F, required emergency reintubation and ventilation. Otolaryngological evaluation revealed bilateral vocal cord paralysis with one vocal cord showing evidence of acute paralysis and the other showing evidence of chronic paralysis. She eventually required a permanent tracheotomy. The patient had undergone previous cardiac surgical procedures to correct Fallot's tetralogy as a neonate and as a child. At those times, there were no recognized symptoms of transient or permanent vocal cord dysfunction. This case emphasizes the importance of identifying patients with preexisting unilateral vocal cord paralysis before performing neurosurgical procedures such as ACD/F, which can place the only functioning vocal cord at risk for paralysis. Guidelines for identifying patients with preexisting unilateral vocal cord paralysis and for modifying the surgical procedure for ACD/F to prevent the catastrophic complication of bilateral vocal cord paralysis are discussed.
作者报告了一例罕见病例，一名患者在接受颈椎前路椎间盘切除融合术（ACD/F）后出现双侧声带麻痹。该患者既往因心脏外科手术存在单侧声带麻痹，临床上无症状且未被识别。患者为41岁女性，在接受C6 - 7 ACD/F术后拔管时出现急性呼吸喘鸣和呼吸功能不全，需要紧急重新插管和通气。耳鼻喉科评估显示双侧声带麻痹，一侧声带显示急性麻痹迹象，另一侧显示慢性麻痹迹象。她最终需要永久性气管切开术。该患者曾在新生儿期和儿童期接受过心脏外科手术以纠正法洛四联症。当时，未发现有短暂或永久性声带功能障碍的症状。该病例强调了在进行诸如ACD/F等神经外科手术前识别存在既往单侧声带麻痹患者的重要性，因为此类手术可能使唯一功能正常的声带面临麻痹风险。文中讨论了识别存在既往单侧声带麻痹患者以及修改ACD/F手术程序以预防双侧声带麻痹这一灾难性并发症的指南。
