内視鏡下披裂軟骨内転術（EAAS）—術前トレーニングと手術のコツ—

概要

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Arytenoid adduction is the most effective procedure for improving voice function in patients affected by unilateral vocal fold paralysis, but it is often associated with severe complications following airway obstruction. We report on the principle operative procedures for our novel and less invasive Endoscopic-assisted Arytenoid Adduction Surgery (EAAS). This paper aims to describe the safe performance of the EAAS procedure resulting in the lowest chance of severe complications.<BR>Before performing clinical procedures, we recommend many practice trials with clinically extirpated larynges damaged by laryngeal cancer. The 3 axes of these extirpated larynges were measured with CT and X-ray images. We demonstrated insertion techniques upon the fixed larynges with penetration and loop needles.<BR>EAAS was performed with a curved laryngopharyngoscope using a laryngeal videoendoscope under general anesthesia. Two needles were inserted from the cricothyroid ligament and nylon threads were passed around the muscular process with our novel technique. After the extraction of the laryngopharyngoscope, the two threads were tied between a spacer.<BR>Sixteen patients underwent EAAS. Post-operatively, most patients achieved a maximum phonation time of more than 10 seconds and a mean airflow rate of less than 200ml⁄second.<BR>Practice is necessary for successful EAAS and practice makes perfect.