Transoral arytenoid adduction with minimal cervical incision
Transoral arytenoid adduction with minimal cervical incision
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经口杓状软骨内收，最小宫颈切口
DOI：
10.1002/lary.25096
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
S. Choi
中科院分区：
文献类型：
--
作者：
M. Kwon;S. Choi
杓状软骨内收术（AA）是一种用于单侧声带麻痹（UVFP）患者的近似喉成形术，由莫里森于1948年首次介绍。该手术的主要机制是通过向环杓外侧肌（LCA）方向拉动杓状软骨的肌突来重新定位声带。当存在较大的后声门间隙、声带水平差或声带严重缩短时，AA特别有用;它可以弥补I型甲状腺成形术的局限性。目前使用的最常见的AA技术是由Isshiki建立的。这种传统的方法需要做一个4厘米到5厘米长的皮肤切口，并切断下咽缩肌，以接近甲状软骨的后缘。此外，为了定位和操纵肌突，有时需要过度旋转喉部和环甲（CT）关节脱位或部分切除甲状软骨后缘。这些不仅可能导致美容问题，还可能导致呼吸道或吞咽功能障碍。有一些关于AA的经甲状腺/前路或经口内镜方法的报告，重点关注与传统AA相比的低水平侵入性和增强的可行性。然而，所有这些方法都是在尸体或摘除的喉上进行的，仍然处于实验阶段。在这里，我们介绍了一种新的外科手术，经口AA与最小的颈部切口，这降低了AA程序的侵入性。
INTRODUCTION Arytenoid adduction (AA) is a type of approximation laryngoplasty for unilateral vocal-fold paralysis (UVFP) patients that was firstly introduced by Morrison in 1948. The main mechanism for this procedure is vocal fold repositioning by means of pulling the muscular process of the arytenoid cartilage in the direction of the lateral cricoarytenoid (LCA) muscle. AA is especially useful when there is a large posterior glottal gap, vocal fold level difference, or severely foreshortened vocal fold; it can compensate for the limitation of type I thyroplasty. The most common AA technique currently in use was established by Isshiki. This conventional method requires making a 4-cmto 5-cm-long skin incision and cutting the inferior pharyngeal constrictor muscle to approach the posterior edge of the thyroid cartilage. Furthermore, to locate and manipulate the muscular process, excessive rotation of the larynx and dislocation of the cricothyroid (CT) joint or a partial resection of the posterior edge of the thyroid cartilage is sometimes necessary. These may result not only in cosmetic problems but also airway or swallowing dysfunctions. There have been some reports of transthyroidal/anterior approaches or transoral endoscopic methods of AA focused on the low level of invasiveness and enhanced feasibility as compared to conventional AA. However, all of these methods have been performed on cadaveric or extirpated larynges and still remain experimental. Here, we introduce a novel surgical procedure, transoral AA with a minimal cervical incision, which decreases the invasiveness of the AA procedure.