Możliwości naprawcze porażeń fałdów głosowych w wyniku operacji gruczołu tarczowego

Abstract

Introduction: Surgery of the thyroid gland remains the main cause of bilateral vocal cord palsy (VCP). Ventilation problem is the main problem in such situations. There are a couple of corrective surgical procedures in the case of VCP. The aim of our study was to show the possibility of widening of the glottis, and to evaluate the techniques and effects of surgical treatments due to bilateral VCP resulting from thyroid gland surgery. Material and methods: Five methods of surgical treatment were used: laser-assisted posterior cordectomy, according to Denis and Kashima; laser-assisted bilateral medial arytenoidectomy, as proposed by Crumley; laser-assisted posterior ventriculocordectomy, as described by Pia; laser-assisted total arytenoidectomy with posterior cordectomy, as presented by Ossoff; and laterofixation, according to Lichtenberger. The postoperative patient's subjective improvement was assessed using visual analogue scale. Results: Between 1998 and 2014 we operated on 270 patients with bilateral VCP. Paresis occurred as the result of the iatrogenic effect of thyroid gland surgery in 255 patients (94.4%) vs. 15 (7.6%) from other causes. The majority of our patients (77.6%) had undergone laser arytenoidectomy with posterior partial cordectomy, and in 13.7% of them Lichtenberger laterofixation had been performed. Ossoff 's surgery gives good ventilation results: successful decannulation (62.9% after first surgery; 97.6% final rate) and significant subjective ventilation improvement in 96% of patients.

Continuous Intraoperative Nerve Monitoring of a Non-Recurrent Laryngeal Nerve: Real-Life Data of a High-Volume Thyroid Surgery Center

“…A rare but serious issue after thyroid surgery is a bilateral VCP, as affected patients cannot breathe adequately due to an airway obstruction caused by the paralyzed vocal folds [ 8 , 9 ]. Bilateral VCP usually requires a tracheostomy or other airway improvement surgery [ 10 ]. The gold standard of thyroid surgery is the visual identification of the RLN, but several publications emphasize the role of an intermittent intraoperative nerve monitoring (IONM) to support the prevention of injury to the RLN and preservation of its functional integrity [ 11 , 12 ].…”