Unilateral Recurrent Nerve Paralysis Research Articles

Funktionelle und elektromyographische Langzeitergebnisse nach primärer mikrochirurgischer Versorgung des N. laryngeus recurrens*

Six patients with unilateral recurrent nerve paralysis underwent phoniatric follow-up after neurolysis or primary microsurgical repair of the recurrent laryngeal nerve. Four patients were controlled by electromyography of the vocal muscle 14 to 80 months post-operatively. In six patients the paralyzed vocal cords were in median to paramedian position with sustained muscle tonus. Phoniatric parameters were found to be close to the average range in healthy persons. EMG findings indicated degenerative neurogenous paralyses in two patients, signs of reinnervation in another. In one case biphasic action potentials could be recorded.

経皮的声帯内注射の治療成績とその影響因子について

The result of transcutaneous intrafold injection and its influencing factors were studied for fifty five procedures in fifty two patients with unilateral recurrent nerve paralysis. Maximum phonation time, mean air flow rate and amplitude perturbation quotient of the voice were normalized or improved after the procedures more than 85%. In general assessment with functional and acoustic examinations, 76% of the procedures showed significant improvement. The paralysis after the thoracic surgery, right vocal fold paralysis and the paralysis complicated with sulcus vocalic tended to have insufficient improvement after injection. The most significant correlation to the result was shown in the degree of vocal fold augmentation immediately after injection. It was depend on the surgeon's technique and the patient's problems such as an anatomical abnormality of the larynx and an insufficient inhibition of the gag reflex.

発声にともなう麻ひ声帯の形状変化に関する画像解析 空気力学的な力の関与について

The development of digital radiography (DR) has made it possible to analyze the contour of the laryngeal soft tissue structures in more detail than the conventional screen-film method. We analyzed the contour of the paralyzed vocal cord during phonation using motion subtraction technique. Forty four patients with unilateral recurrent nerve palsy were examined. The images were obtained by means of frontal tomography of the larynx during quiet inspiration and normal (expiratory) phonation. Tomography during inspiratory phonation was also examined in ten patients who can perform it. The thickness of the slices was 5.0 mm. The authors found that the free margin of the paralyzed vocal cord shifted by the aerodynamic power along the direction of the air flow, i.e. it shifted to the cranial direction during normal phonation and to the caudal during inspiratory phonation. The displacement phenomenon of the paralyzed vocal cord was significantly correlated with the degree of vocal cord atrophy (p less than 0.01). The result would indicate that the aerodynamic power during phonation is one of the factors eliciting the higher position of the paralyzed vocal cord during phonation, in addition to its anatomical displacement due to abduction of the paralyzed arytenoid. This notion should be taken into consideration in selecting the surgical approach for the treatment of unilateral recurrent nerve palsy.

片側反回神経麻ひに対するアテロコラーゲン声帯内注入療法

Seven patients with unilateral recurrent nerve paralysis underwent vocal fold augmentation by intracordal injection of atelocollagen. Injection was done through direct laryngoscopy under general anesthesia. An additional injection was necessary in two cases and was done transcutaneously under local anesthesia. Five patients were followed as long as six months after injection. Four of them received 3. 5% atelocollagen injection and their phonatory function improved dramatically except one patient. The other received 3% atelocollagen injection. But, his vocal fold became again atrophied within a week after injection. Thus 3. 5% atelocollagen should be a choice for vocal fold augmentation. In addition, some physical properties of atelocollagen in the vocal fold was said to be like those of vocal fold itself. Therefore, atelocollagen can be injected into any layer of the vocal fold without specific technical care.

A fundamental study of injectable collagen in vocal rehabilitation

Vocal fold augmentation therapy has been accepted as a choice of treatment for glottic insufficiency due to unilateral recurrent nerve paralysis, vocal fold atrophy and sulcus vocalis. Various injectable materials have so far been investigated and clinically utilized. Although silicone and teflon are materials most widely used currently, our clinical experiences have indicated that they are not totally dependable because of such problems as tissue rection and instability of the volume.Recently, atelocollagen extracted from young calf skin has been reported to be an excellent injectable material and its application to phonosurgery has been described by Ford without investigating its long-termed safety and histocompatibility, and its effect on the vocal fold vibrations after the injection.This lack of investigation on the injection therapy of atelocollagen has prompted the animal experiments to study histological attitude of collagen in the vocal fold and the vocal fold vibration after the injection. The collagen at a concentration of 35, 20 and 10mg/ml were injected into canine vocal folds. The follow up period ranged from 3 days to 9 months after the injection. It was revealed that the most suitable concentration of the collagen for maintenance of the contour of the vocal fold was 35mg/ml, although the volume of the vocal fold tended to decrease very slightly during three days after the injection. Histological studies confirmed no inflammatory reaction in the surrounding tissue after the injection and no migration of collagen during the following-up period. Vibrations of the injected vocal folds during phonation were photographed with an ultra-high speed motion camera and frame-by-frame analyses were done. Mucosal wave-like movements were satisfactority preserved even when the collagen stayed in the submucosal superficial layer of the vocal fold. The result indicates that atelocollagen can be injected into any layers of the vocal fold without specific technical care. Owing to this advantage, use of the atelocollagen will expand indication of augmentation therapy.

Surgical Treatment for Voice Disorder due to Unilateral Recurrent Nerve Palsy

In this paper, various methods of surgical treatment for voice disorder due to unilateral recurrent nerve palsy were briefly reviewed. The author emphasized the necessity of the choice of different approaches depending on the width of the glottal chink; injection or insertion method for the narrow glottal chink (paramedian fixation) and arytenoid adduction for the wide glottal chink (intermediate fixation) and for the difference in the level of the both vocal folds.

Misadventures with injectable polytef (Teflon).

The intracordal injection of polytef (Teflon)-glycerine suspension has proved most effective in relieving dysphonia due to unilateral recurrent nerve paralysis. However, if errors in the technique of injection are committed or if patients are not properly selected, a potentially good result will not be achieved or the voice will be made worse.

INTRACORDAL INJECTION OF SILICONE IN SELECTED DYSPHONIAS.

THE EFFECTIVENESS of intracordally injected Teflon in restoring or improving the voice in a variety of dysphonias, particularly unilateral recurrent nerve paralysis, has been established by Arnold^1-5and corroborated by others.^6,7Specific indications for the use of Teflon are restricted to situations in which dysfunction is permanent. Where there is doubt as to whether cordal function will return, injection of Teflon must be withheld until at least six months have elapsed. Should this rule not be observed and a paralyzed vocal cord spontaneously recover after the injection of Teflon, the voice would be rendered permanently disturbed instead of returning to its normal preparalytic state by virtue of the foreign material within the substance of the cord acting as a benign space-occupying lesion. There is a period of time, therefore, during which the patient with dysphonia from unilateral palsy of uncertain prognosis must endure his disability with no immediate