Management of vocal fold lesions in difficult laryngeal exposure patients in phonomicrosurgery
Management of vocal fold lesions in difficult laryngeal exposure patients in phonomicrosurgery
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DOI：
10.1016/j.anl.2010.10.006
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发表时间：
2011-06-01
影响因子：
1.7
通讯作者：
Ito, Juichi
中科院分区：
文献类型：
--
作者：
Ohno, Satoshi;Hirano, Shigeru;Ito, Juichi
目的：直接喉镜下的喉内显微手术是一种成熟的声音外科手术。充分的喉部暴露是必要的，但在某些情况下，无法获得足够的声门视图，导致治疗失败。本研究报告了如何管理声带病变在困难的喉暴露（DLE）cases.Methods：从2003年至2009年，212例患者接受了喉内显微手术在京都医疗中心和京都大学医院。在三角形喉镜下，在嗅（Boyce-Jackson）位下进行声带显微手术，以暴露喉部。然而，在DLE病例中，根据需要修改Me姿势和喉镜，以充分暴露病变。结果：14例（6.6%）患者出现DLE。通过选择合适的体位和喉镜，DLE患者的喉内显微手术是可能的。然而，两名患有前蹼和声带囊肿的患者无法完成手术，这两名患者都需要随后的翻修手术。表面麻醉下的纤维光学喉手术是一种可行的替代这些cases.Conclusions：Phonosurgery是可能的，即使在DLE的情况下。根据需要修改直接喉镜的设置以获得足够的暴露是很重要的。纤维光学手术也可用于某些困难的情况。(C)2010爱思唯尔爱尔兰有限公司版权所有。
Objectives: Endolaryngeal microsurgery using a direct laryngoscope is a well-established procedure in phonosurgery. Adequate laryngeal exposure is essential, but in some cases sufficient view of the glottis cannot be obtained, leading to treatment failure. This study reports how to manage vocal fold lesions in difficult laryngeal exposure (DLE) cases.Methods: From 2003 to 2009, 212 patients underwent endolaryngeal microsurgery at Kyoto Medical Center and Kyoto University Hospital. Phonomicrosurgery was performed under sniffing (Boyce-Jackson) position with triangular shaped laryngoscope for laryngeal exposure. However, in DLE cases, Me posture and laryngoscope were modified as needed to adequately expose the lesion. Fiberoptic laryngeal surgery (FLS) with local anesthesia was also used for the most difficult cases.Results: The number of the patients with DLE was 14 (6.6%). Endolaryngeal microsurgery was possible in DLE cases by selecting the appropriate posture and laryngoscope. However, the procedure could not be completed in two patients with an anterior web and a vocal fold cyst, both of which required a subsequent revision procedure. Fiberoptic laryngeal surgery with topical anesthesia was a feasible alternative for these cases.Conclusions: Phonosurgery was possible even in DLE cases. It is important to modify the setup of direct laryngoscopy as needed to obtain adequate exposure. Fiberoptic surgery may also be used in certain difficult cases. (C) 2010 Elsevier Ireland Ltd. All rights reserved.