RECHERCHES SCIENTIFIQUES

PLACE DE L’ARYTÉNOÏDECTOMIE SUBTOTALE AU LASER CO2 DANS LE TRAITEMENT DES PARALYSIES LARYNGÉES BILATÉRALES

Référence932
Année2015
TypeThèse
Lien document
AuteurSounni A
DisciplineOto-rhino-laryngologie
EncadrantBenmansour N

Introduction
Bilateral vocal fold paralysis differs in overall and dissociated diplegia. The mechanisms are varied. The most common causes are iatrogenic recurrent laryngeal paralysis after cervical spine surgery, including thyroid. The diagnostic and therapeutic management of this laryngeal immobility has seen many advances in recent years. The aim of this work is to show the place of arytenoidectomy CO2 laser in the treatment of this bilateral vocal fold paralysis.
Materials and methods Our study is retrospective about 30 patients with bilateral vocal fold paralysis in closure. The average age was of years .the etiology was total thyroidectomy in 28 cases, irradiation in 1 cases and idiopathic in 1 cases.
The treatment consisted of an emergency tracheotomy in five cases.25 patients received laser arytenoidectomy ofCO2, 5 patients received the partial posterior cordotomyand laser arytenoidectomy of CO2.
Results
The average age of patients was 51.5 years, with a female predominance with a rate of 90% of cases. Among the causes identified, there was 93% of total cases are post-thyroidectomy, 1 case secondary to cervical radiotherapy and a case without a clear cause (idiopathic). The nasofibroscopy objectified bilateral paralysis in adduction in 25 cases and in paramedian position in 5 cases. 25 patients have benefited a subtotal arytenoidectomy endoscopic CO2 laser transorally and 5 patient’sbéniciés a arytenoidectomy after fail subtotal posterior cordectomy

Rehabilitation was almost systematic pre- and postoperatively. The postoperative course was uneventful; apart from false transient liquid roads regressed after speech therapy. 4 patients carrying a tracheotomy have benefited from a closed port of postoperative tracheostomy. The decline is 6 to 24 months.
Discussion
A variety of surgical procedures, especially endoscopic have been proposed in the treatment of laryngeal adduction diplegia.
Endoscopic or cervical approach, the various processes must provide goodrespiratory outcomes, with an acceptable compromise on the phonatory plane, the voice is even weaker than the vocal cord is involved.
The subtotal arytenoidectomy CO2 laser unlike externally techniques allows reliable and durable breathing, less impact on voice and less risk of choking.
Conclusion
The endoscopic approach has greatly simplified the management allows it to balance on one hand the patient’s life expectancy, comorbidities, the need to maintain a phonation, and on the other hand the character more or less invasive and anatomical and functional consequences