長期経鼻気管内挿管後に生じた声帯癒着症--いわゆるPseudo-bilateral abductor paralysis

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A 3-year-old female suspected of laryngomalacia had nasotracheal intubation for 23 days after birth. Tracheotomy was performed because of asphyxia on removal of the nasotracheal tube. Tracheostomy tube was left in place thereafter because of difficulty of decannulation for three years. During these years, repeated direct laryngoscopies revealed "bilateral vocal cord paralysis" with the cords in paramedian position, and finally s little adhesion between the posterior margin of the true vocal cord was discovered. This adhesion was divided with a knife and forceps and the both cords were apart and began to move well with respiratory effort.The day after the operation, tracheostomy tube was removed and the tracheostoma closed spontaneously. The patient could breathe and speak without difficulty.The histopathological finding of this adhesion removed by operation, was characterized by chronic inflammatory granulation tissue.In regard to this case, the several short comments could be made as follows.1. The true diagnosis of the case reported was vocal cord adhesion after prolonged nasotracheal intubation. However, it could be called as "pseudo-bilateral abductor paralysis" which Jaffe had already reported in 1973. We apt to misdiagnose vocal cord adhesion as vocal cord paralysis.2. Infection, as well as vocal cord standstill caused by trachestomy, might be some of the main factors of development of adhesion.3. The vocal cords move well and prevent a further adhesion, after removing adhesion by the operation and phonation and breathing through larynx were satisfactory
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長期経鼻気管内挿管後に生じた声帯癒着症--いわゆるPseudo-bilateral abductor paralysis

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