Ejnell's Laterofixation of the Vocal Cord with Endo-extralaryngeal Needle Carrier

Abstract

Ejnell's laterofixation of the vocal cord has been our first choice of surgical management for patients with laryngeal obstruction due to bilateral vocal cord paralysis. It is, however, difficult to insert the needle to the appropriate position of the vocal cord from outside of the larynx. Thus, we have introduced endo-extralaryngeal needle carrier (EENC) for Ejnell's operation to overcome this problem. When compared to the conventional procedure, EENC had advantages. 1) The surgical procedure was simpler and quicker. 2) Less skin incision on the neck was necessary. The EENC also had disadvantages. 1) The existing EENC is large for Japanese larynges and its use is problematic. 2) Due to its curved needle, the thread is guided in the direction lower than the insertion point inside the larynx, resulting in the vocal cord being pulled downward. 3) The thread directly penetrates thyroid cartilage, therefore fine adjustments of thread traction is not easy. 4) There is possible risk of intra-laryngeal bleeding. In conclusion, EENC is useful instrument for Ejnell's operation; however surgeons should be aware of its possible shortcomings.