迷走神经损伤定位检查有助于单侧声带麻痹的病因诊断

目的探讨迷走神经损伤定位检查用于单侧声带麻痹病因诊断中的价值。方法对1例半年未能明确病因的单侧声带麻痹患者的诊疗过程进行回顾分析。结果本例因声音嘶哑半年就诊,在当地多家医院行相关医技检查均诊断为左侧特发性声带麻痹,予相应治疗症状无改善,来我院拟行声带自体脂肪注射术闭合声门。入我院后经追问病史、仔细查体及电子喉镜下吞咽功能检查发现左侧梨状窝有食物残留,考虑迷走神经节以上部位病变所致声带麻痹,经颅底增强MRI检查诊断为颈静脉孔区良性肿瘤。由于病变部位特殊,患者拒绝手术遂行伽马刀治疗,随访1年,肿瘤无变化。结论对于单侧声带麻痹患者切勿轻易诊断为单纯声带麻痹。电子喉镜下吞咽功能检查有助于确定迷走神经损伤部位,根据损伤部位有的放矢地进行检查,对单侧声带麻痹的病因诊断有临床指导价值。

Localization Examination of the Vagus Nerve in Determining the Cause of the Unilateral Vocal Cord Paralysis

Objective To evaluate the value of localization examination of the vagus nerve in determining the cause of the unilateral vocal cord paralysis. Methods The diagnostic process of a patient with unknown cause of unilateral vocal cord paralysis was retrospectively reviewed. Results The patient presented to our center for hoarseness for half a year. Idiopathic left side vocal cord paralysis was diagnosed because no positive findings were detected in many hospitals. After corresponding treatment, the vocal cord paralysis had no sign of recovery, and then the patient came to our hospital for improving his voice by autologous fat injection into the vocal fold. After medical history collection and careful physical examinations, the patient underwent electronic fibrolaryngoscope swallow study and the result showed residual food in the left pyriform sinus. Those findings suggested that damaged level of the vagus nerve was above the ganglion of the vagus nerve. Contrast enhanced MRI of the skull base found a mass in the jugular foramen region, considered as benign tumor. The patient refused surgical treatment and received gamma knife radiosurgery. The tumor was not changed in the 1-year follow-up. Conclusion Patients with unilateral vocal cord paralysis should not be diagnosed as vocal cord paralysis simply. The electronic fibrolaryngoscope swallow study is helpful for determining the impaired site of the vagus nerve. Then, examination should be focused on the impaired site, and the cause of the vocal cord paralysis may be found.