bilateral vocal fold immobility: diagnosis and treatment imobilidade bilateral de pregas vocais: diagnóstico e tratamento

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ID: 246556
2011
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Abstract
Vocal fold immobility may be due to bilateral neurogenic paralysis, cricoarytenoid joint fixation, laryngeal synechiae, or posterior glottic stenosis. Treatment aims to establish a patent airway and preserve the function of the glottic sphincter and voice quality. OBJETIVES: To analyze the diagnostic and therapeutic approaches in cases of bilateral vocal fold immobility seen at our unit. MATERIALS AND METHODS: A retrospective study of 35 patient registries at our unit with a diagnosis of bilateral vocal fold immobility; the etiology and treatment results were evaluated. RESULTS: Among the patients, 18 (51.4%) were cases of bilateral vocal fold palsy, and 17 (48,6%) were cases of posterior glottic stenosis. Patients with bilateral palsy underwent unilateral subtotal arytenoidectomy, and patients with stenosis were treated with the microtrapdoor flap technique, subtotal arytenoidectomy, and/or posterior cricoidotomy (Rethi). CONCLUSION: Bilateral vocal fold immobility is a potentially fatal condition; it is essential to differentiate vocal fold palsy from fixation to choose the appropriate treatment. Subtotal arytenoidectomy with microscopy is our surgery of choice for treating bilateral paralysis; the technique for treating stenosis depends on the amount of stenosis.
A Imobilidade Bilateral de Pregas Vocais pode ser decorrente de paralisia neurogênica bilateral, fixação de articulação cricoaritenoidea, sinequia laríngea ou estenose glótica posterior. O tratamento visa a restabelecer uma via aérea pérvia mantendo a função esfincteriana glótica e a qualidade vocal. OBJETIVOS: Analisar os métodos diagnósticos e terapêuticos dos casos de Imobilidade Bilateral de Prega Vocal atendidos em nosso serviço. MATERIAIS E MÉTODOS: Estudo retrospectivo de 35 prontuários de pacientes atendidos em nosso serviço com diagnóstico de Imobilidade Bilateral de Prega Vocal, sendo avaliados fatores etiológicos e resultados terapêuticos. RESULTADOS: Dentre os pacientes, 18 (51,4%) eram casos de paralisia bilateral de pregas vocais e 17 (48,6%), de estenose glótica posterior. Os pacientes com paralisia bilateral foram submetidos à aritenoidectomia subtotal unilateral e os com estenose, submetidos à "microtrapdoor flap", aritenoidectomia subtotal e/ou cricoidotomia posterior (Rethi). CONCLUSÃO: A imobilidade bilateral de prega vocal é um quadro potencialmente fatal e a diferenciação entre paralisia e fixação de pregas vocais é essencial para a escolha do método terapêutico. A aritenoidectomia subtotal, via microscópica, é nossa opção cirúrgica para o tratamento da paralisia bilateral e nas estenoses a escolha da técnica varia conforme o grau de estenose.
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Authors ;José Antonio Pinto;Luciana Ballester de Mello Godoy;Valéria Wanderley Pinto Brandão Marquis;Thiago Branco Sonego;Carolina de Farias Aires Leal
Journal cardiovascular diabetology
Year 2011
DOI
10.1590/S1808-86942011000500010
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942011000500010
Keywords
paralysis vocal cordsotorhinolaryngology

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