Paralysis


Categories: CHRONIC STENOSIS OF THE LARYNX AND TRACHEA
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Bilateral abductor laryngeal paralysis causes severe

stenosis, and usually tracheotomy is urgently required. In cadaveric

paralysis both cords are in a position midway between abduction and

adduction, and their margins are crescentic, so that sufficient airway

remains. Efforts to produce the cadaveric position of the cords by

division or excision of a portion of the recurrent laryngeal nerves,

have been failures. The operation of ventriculocordectomy consists

in removing a vocal cord and the portion or all of the ventricular

floor by means of a punch forceps introduced through the direct

laryngoscope. Usually it is better to remove only the portion of the

floor anterior to the vocal process of the arytenoid. In some cases

monolateral ventriculocordectomy is sufficient; in most cases,

however, operation on both sides is needed. An interval of two months

between operations is advisable to avoid adhesions. In almost all

cases, ventriculocordectomy will result in a sufficient increase in

the glottic chink for normal respiration. The ultimate vocal results

are good. Evisceration of the larynx, either by the endoscopic or

thyrotomic method, usually yields excellent results when no lesion

other than paralysis exists. Only too often, however, the condition is

complicated by the results of a faultily high tracheotomy. A rough,

inflexible voice is ultimately obtained after this operation,

especially if the arytenoid cartilage is unharmed. In recent bilateral

recurrent paralysis, it may be worthy of trial to suture the recurrent

to the pneumogastric. Operations on the larynx for paralytic stenosis

should not be undertaken earlier than twelve months from the inception

of the condition, this time being allowed for possible nerve

regeneration, the patient being made safe and comfortable, meanwhile,

by a low tracheotomy.





;