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Operative Stimmrehabilitation bei einseitiger Lähmung des N. laryngeus inferior (recurrens)

Surgical voice rehabilitation in unilateral vocal fold paralysis

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Zusammenfassung

Die unilaterale Parese eines Nervus recurrens führt zu einem unvollständigen Glottisschluss und damit zu einer empfindlichen Einbuße der Stimmleistungsfähigkeit. Der lange Verlauf des N. recurrens exponiert ihn in besonders hohem Maße für iatrogene Schädigungen bei einer Vielzahl von Interventionen unterschiedlicher Fachgebiete.

Die indirekte Laryngoskopie bestätigt die Verdachtsdiagnose. Für die weitere Diagnostik kommt der laryngealen Elektromyographie besondere Bedeutung zu. Sie erlaubt die Abgrenzung zur Ankylose im Krikoarytaenoidgelenk und in vielen Fällen eine zuverlässige Prognose der Ausheilungswahrscheinlichkeit. Während ungünstige Verläufe mit hoher Sicherheit vorhergesagt werden können, ist die komplette Ausheilung jedoch schwierig prognostizierbar.

Die Behandlung der unilateralen Rekurrensparese ist überwiegend konservativ. Auch bei dauerhaft eingeschränkter Beweglichkeit einer Stimmlippe wird in der Mehrzahl der Fälle durch Kompensationsmechanismen eine befriedigende Stimmbildung erreicht. Für den Fall eines persistierenden glottischen Restspalts mit subjektiv empfundener Einschränkung der Stimmleistungsfähigkeit stehen heute differenzierte Techniken der operativen Stimmrehabilitation zur Verfügung. Die vorliegende Arbeit bietet eine Übersicht der operativen Verfahren zur Stimmverbesserung, die an spezialisierten Zentren zur Verfügung stehen.

Abstract

Unilateral recurrent nerve paralysis leads to glottic insufficiency, significantly reducing vocal ability. Due to its unusually long course, the recurrent laryngeal nerve is prone to iatrogenic lesions involves many medical fields generally with little expertise in voice disorders. Whenever the etiology is uncertain, a complete diagnostic work-up is mandatory. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytenoid joint. Moreover in many cases laryngeal electromyography yields a reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Speech therapy is the treatment of choice in cases of unilateral recurrent nerve palsy. Patients with persistent glottal gap may express the wish for surgical voice rehabilitation. Nowadays a broad spectrum of endoscopic and open approaches are available for this purpose. This review describes advanced techniques of voice-improving surgery available in specialized centers today.

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Authors and Affiliations

  1. Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart – Katharinenhospital, Kriegsbergstraße 60, 70174, Stuttgart, Deutschland

    C. Sittel

  2. Klinik für Hals-, Nasen- und Ohrenheilkunde der Universität Heidelberg, Heidelberg, Deutschland

    N. Bosch & P.K. Plinkert

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  1. C. Sittel
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  2. N. Bosch
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  3. P.K. Plinkert
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Correspondence to C. Sittel.

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Sittel, C., Bosch, N. & Plinkert, P. Operative Stimmrehabilitation bei einseitiger Lähmung des N. laryngeus inferior (recurrens). Chirurg 79, 1055–1064 (2008). https://doi.org/10.1007/s00104-008-1550-6

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