レーザー手術後の喉頭軟骨壊死

Abstract

A 70 y. o. -male underwent radiation therapy for laryngeal cancer in 1962. He also had dyspnea after a train accident in May 1991, and both vocal folds were fixed in the midline position. He underwent laser arytenoidectomy in April 1992, and had a laser cordotomy in January 1994. After the operation, his throat turned red, and conservative treatment was initiated assuming that this was perichondritis. However, the patient didn't recover. A diagnosis of laryngeal chondronecrosis was made, and he had his laryngeal cartilage removed by laryngofissure in July 1994. In order to prevent miswallowing, he had a laryngeal reconstruction using an epiglottic roll technique in the same year. The underlying etiology of the problem was a disturbance of the circulation in the perichondrium as a result of the irradiation. The laser induced heat damage caused the perichondritis, and it was believed that this advanced to the stage of chondritis, and then to chondronecrosis. Considering the period after the irradiation in this case, and the fact that the ischemic changes in the perichondrium after the irradiation were irreversible, it was thought that this may have caused the laryngeal chondronecrosis by the additional burden of sub-damage like heat and following an infection.