レーザー披裂軟骨切除術を施行した両側反回神経麻痺の2例

抄録

An airway enlargement procedure is performed to close tracheostomies performed for bilateral vocal fold palsy. Vocal fold laterofixation by Ejnell’s method is the most commonly used airway enlargement procedure, but it widens the anterior glottal gap and impaires vocal function. On the other hand, arytenoidectomy widens the posterior glottal gap and can preserve vocal function. We report two cases of bilateral recurrent laryngeal nerve palsy in whom we performed arytenoidectomy.

Case 1: A patient who developed bilateral recurrent laryngeal nerve palsy after undergoing total thyroidectomy for papillary thyroid cancer at another hospital had an MPT of 10 seconds, MFR of 230 ml/s, and breath hoarseness of G1 and B1 on the GRBAS scale. Postoperatively, the patient’s voice function did not deteriorate and we closed the tracheostomy without dyspnea.

Case 2: Similar to Case 1, a patient who had developed bilateral recurrent laryngeal nerve palsy after undergoing total thyroidectomy for papillary thyroid cancer at another hospital was referred to our hospital. The preoperative MPT was 8.6 seconds, MFR was 500 ml/s, and the breath hoarseness was G2 and B2 on the GRBAS scale. Postoperatively, the MPT remained unchanged, the voice function was preserved, and we closed the tracheostomy without dyspnea.

Arytenoidectomy tends to preserve the voice function more easily than Ejnell’s method because it widens only the posterior glottal gap, making arytenoidectomy an effective technique for patients with bilateral vocal fold palsy.