両側性反回神経麻痺症例の臨床的観察

Abstract

We clinically investigated 19 cases of bilateral recurrent laryngeal nerve paralysis that were referred to our clinic over the 8-year period of 1993 to 2000. Eleven males and 8 females were studied. Laryngeal nerve paralysis was often seen in the 4th and 6th decades of life for males and in the 6th decade of life for females. Thyroid surgery was the most frequent cause, and the most common complaint was dyspnea.If the patient suffers dyspnea at rest, then a tracheostomy should be performed initially. For the next step, we need to strategize the best course of treatment for the bilateral recurrent laryngeal nerve paralysis according to the patient's needs in order to keep the quality of voice or to provide relief from dyspnea.There were two cases of paralysis following endotracheal intubation whose vocal cord movement recovered in 2 months.We performed laser cordectomies on 6 patients and as well as Woodman's operation on 4 patients to widen the airway. There were 2 cases that suffered dyspnea from stenosis of the airway after receiving laser cordectomey due to the granulation generated from the wound after vaporizaton of the posterior half of the glottis. It appears that Woodman's operation was more reliable than laser cordectomy in keeping the widened airway in good condition for a long time after surgery.