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J Korean Soc Laryngol Phoniatr Logop > Volume 20(2); 2009 > Article
Journal of The Korean Society of Laryngology, Phoniatrics and Logopedics 2009;20(2): 118-125.
양측성 성대 마비의 치료 원칙
김태욱, 손영익
성균관대학교 의과대학 삼성서울병원 이비인후과학교실
Management Principles of Bilateral Vocal Fold Immobility
Tae-Wook Kim, Young-Ik Son
Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
ABSTRACT
Bilateral vocal fold immobility (BVFI) is a challenging condition which may result from diverse etiologies including vocal fold paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar. Most patients present with dyspnea and stridor, but sometimes with a breathy dysphonia. Careful history taking, laryngoscopic evaluation under general anesthesia or awaken status, laryngeal EMG, and imaging studies with CT and/or MRI are helpful for providing a precise diagnosis and planning appropriate managements. In children, congenital neurological disorder is one of the most common etiologies, and spontaneous recovery has been reported in more than 50% of cases. Therefore, observation for more than 6 months while securing the upper airway with tracheostomy if needed is a generally accepted rule before deciding any destructive procedure to be undertaken. In children with advanced posterior glottic stenosis, laryngotracheal reconstruction with rib cartilage graft should be considered. In contrast to children, BVFI most commonly occurs as sequalae of surgical complication in adults. Diverse static or dynamic procedures can be applied; posterior cordotomy, vocal fold lateralization, endoscopic or open arytenoidectomy, arytenoid abduction, and reinnervation, electrical laryngeal pacing, which need to be carefully selected according to each patient's needs and pathophysiology of BVFI.
KEY WORDS: Vocal cord paralysis;bilateral;Laryngostenosis;Ankylosis;Disease management;Surgery;
중심 단어: 양측성 성대 마비;후두협착;치료;수술;
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