Methods of surgical treatment of bilateral vocal fold paralysis.

Abstract

Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.

Ҳиқилдоқнинг Сурункали Паралитик Стенози Бўлган Беморларда Нафас Ва Овоз Функциясини Баҳолаш

“…Ҳиқилдоқнинг сурункали икки томонлама паралитик стенозини ташхислаш ва даволаш бугунги кунга келиб ҳалиям ўз долзарблигини йўқотмаган. Бу ҳиқилдоқ асаб толаси билан ёнма-ён бўлган аъзоларда (қалқонсимон без, трахея, қизилўнгач) ўтказиладиган жарроҳлик амаллари, кўкрак аъзолари ўсмаларида, юрак-қон томир аномалияларида (аневризма, юрак нуқсонлари) ўтказиладиган жарроҳлик амаллари, шунингдек, транспорт ва маиший жароҳатлар ва бошқалар кўп учраётганлиги сабабли ҳисобланади [3,11,13,14].…”

Reconstructive surgeries on the larynx and cervical trachea in children

“…Применение микрохиругической методики для реиннервации гортани решило вопрос о восстановлении функции гортани [58]. В 1973 г. Miehlike A. описал свою технику, заключающаяся в анастомозе между дистальной частью задней ветви ВГН с основным пучком [58]. Авторы описывают использование диафрагмального нерва, так, в своем исследовании Li M. и соавт.…”

“…получили улучшение у 41 из 44 пациентов, которые перенесли реиннервацию гортани при помощи левого диафрагмального нерва. Заметное улучшение подвижности диафрагмы (40-82%) и дыхательной функции наблюдалось в исследуемой группе более года после операции [58]. Другими авторами проводилась модификация предыдущих хирургических методов, однако многие приходили к выводу, что эффективнее и физиологичнее себя показывает прямой анастомоз конец в конец [59,60].…”

Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes

“…In the setting of acute dyspnea and decompensation, a tracheostomy can be used as a first-line treatment modality to bypass the site of obstruction. 3 Other treatment options are ablative static interventions aimed at directly alleviating the site of obstruction. The first such intervention was ventriculocordectomy, which was introduced by Jackson in 1922.…”

“…A range of treatment options have been proposed to address airway obstruction secondary to BVFI. In the setting of acute dyspnea and decompensation, a tracheostomy can be used as a first‐line treatment modality to bypass the site of obstruction 3 . Other treatment options are ablative static interventions aimed at directly alleviating the site of obstruction.…”