Measures against problems encountered during Ejnell's technique
Ejnell's technique has been our first choice in therapy of bilateral vocal cord paralysis. However, some problems have been encountered with this technique during the experience of several cases. These problems and measures taken against them have been assessed. 1. Indication in cases with ad h...
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| Published in | OTOLOGIA FUKUOKA Vol. 49; no. 4; pp. 275 - 278 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
JIBI TO RINSHO KAI
20.07.2003
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0447-7227 2185-1034 |
| DOI | 10.11334/jibi1954.49.4_275 |
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| Abstract | Ejnell's technique has been our first choice in therapy of bilateral vocal cord paralysis. However, some problems have been encountered with this technique during the experience of several cases. These problems and measures taken against them have been assessed. 1. Indication in cases with ad hesion or scar must be carefully decided because Ejnell's technique alone may not give enough glottic space. 2. Position and direction of the needle must be carefully decided before puncture to minimize trauma. 3. The endo-extralaryngeal needle carrier which enables puncture from within the larynx is effective in easy decision of suitable position. 4. A spacer is effective in fixation of the pulling thread. We have found a bio-ceramic button to be suitable as a spacer since the thin profile allows secure fixation of the thread with minimal discomfort, and being nonmetal does not interfere with CT or MRI scans. |
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| AbstractList | Ejnell's technique has been our first choice in therapy of bilateral vocal cord paralysis. However, some problems have been encountered with this technique during the experience of several cases. These problems and measures taken against them have been assessed. 1. Indication in cases with ad hesion or scar must be carefully decided because Ejnell's technique alone may not give enough glottic space. 2. Position and direction of the needle must be carefully decided before puncture to minimize trauma. 3. The endo-extralaryngeal needle carrier which enables puncture from within the larynx is effective in easy decision of suitable position. 4. A spacer is effective in fixation of the pulling thread. We have found a bio-ceramic button to be suitable as a spacer since the thin profile allows secure fixation of the thread with minimal discomfort, and being nonmetal does not interfere with CT or MRI scans. Ejnell's technique has been our first choice in therapy of bilateral vocal cord paralysis. However, some problems have been encountered with this technique during the experience of several cases. These problems and measures taken against them have been assessed. 1. Indication in cases with ad hesion or scar must be carefully decided because Ejnell's technique alone may not give enough glottic space. 2. Position and direction of the needle must be carefully decided before puncture to minimize trauma. 3. The endo-extralaryngeal needle carrier which enables puncture from within the larynx is effective in easy decision of suitable position. 4. A spacer is effective in fixation of the pulling thread. We have found a bio-ceramic button to be suitable as a spacer since the thin profile allows secure fixation of the thread with minimal discomfort, and being nonmetal does not interfere with CT or MRI scans. われわれは、両側声帯麻痺に対する手術には、Ejnell法を第一選択として積極的に施行している。しかし、症例を重ねるに従いいくつかの問題点が明らかになってきた。そこで、これらの問題点と、その対策法について検討した。1. 癒着・瘢痕を伴う例では、糸の牽引だけでは十分な声門開大が得られないことがあるので、適応には慎重を期すべきである。2. 甲状軟骨上の針の刺入位置、刺入方向を的確に決定し、刺入回数を減らすように注意する。3. 刺入位置の決定には、喉頭内腔から針を刺すことができるendo-extralaryngeal needle carrierが有用である。4. 牽引糸の固定には、スペーサーが有用である。われわれの用いているバイオセラム製ボタンは、薄いため違和感が少なく、糸を確実に結紮固定でき、非金属なのでCT、MRIなどの検査に支障を来さないことから、スペーサーに適している。 |
| Author | TOYODA, Ken-ichiro UNO, Toshiyuki TADAKI, Nobuhisa HISA, Yasuo OKANO, Hiroyuki HIROTA, Ryuichi KOIKE, Shinobu BAMBA, Hitoshi BANDO, Hideki |
| Author_FL | 板東 秀樹 只木 信尚 久 育男 岡野 博之 廣田 隆一 馬場 均 宇野 敏行 小池 忍 豊田 健一郎 |
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| Author_xml | – sequence: 1 fullname: HISA, Yasuo organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: BAMBA, Hitoshi organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: TADAKI, Nobuhisa organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: UNO, Toshiyuki organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: KOIKE, Shinobu organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: OKANO, Hiroyuki organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: TOYODA, Ken-ichiro organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: HIROTA, Ryuichi organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine – sequence: 1 fullname: BANDO, Hideki organization: Department of Otolaryngology, Kyoto Prefectural University of Medicine |
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| References | 8) 宇野敏行他: 声帯外方移動術のコツ. 喉頭編(2), JOHNS18: 101-105, 2002. 9) 宇野敏行他: Endo-extralaryngeal needle carrierを用いた声帯外方移動術. 耳鼻49: 36-40, 2003. 3) 久育男他: Ejnell法による声帯外方移動術. 耳鼻臨床90: 1190-1191, 1997. 10) 原浩貴他: 硬性内視鏡を併用して行う声帯外方移動術 (Ejnell法) について. 日気食会報53: 436-440, 2002. 1) Ejnell H et al: A simple operation for bilateral vocal cord paralysis. Laryngoscope 94: 954-958, 1984. 4) 久育男: 声帯外方移動術の実際. 耳鼻臨床94: 96-97, 2001. 5) 本吉和美他: 両側声帯正中位固定症例に対する Ejnell法による声帯外方移動術. 日耳鼻101: 1057-1061, 1998. 6) 田村悦代他: Ejnell法による声門開大術に対する一考察. 日気食会報53: 1-5, 2002. 2) 久育男他: 小児両側喉頭麻痺に対するEjnell法による声帯外方移動術. 耳鼻42: 333-326, 1996. 7) Lichtenberger G: Endo-extralaryngeal needle carrier instrument. Laryngoscope 93: 1348-1350, 1983. |
| References_xml | – reference: 9) 宇野敏行他: Endo-extralaryngeal needle carrierを用いた声帯外方移動術. 耳鼻49: 36-40, 2003. – reference: 10) 原浩貴他: 硬性内視鏡を併用して行う声帯外方移動術 (Ejnell法) について. 日気食会報53: 436-440, 2002. – reference: 1) Ejnell H et al: A simple operation for bilateral vocal cord paralysis. Laryngoscope 94: 954-958, 1984. – reference: 2) 久育男他: 小児両側喉頭麻痺に対するEjnell法による声帯外方移動術. 耳鼻42: 333-326, 1996. – reference: 5) 本吉和美他: 両側声帯正中位固定症例に対する Ejnell法による声帯外方移動術. 日耳鼻101: 1057-1061, 1998. – reference: 3) 久育男他: Ejnell法による声帯外方移動術. 耳鼻臨床90: 1190-1191, 1997. – reference: 7) Lichtenberger G: Endo-extralaryngeal needle carrier instrument. Laryngoscope 93: 1348-1350, 1983. – reference: 8) 宇野敏行他: 声帯外方移動術のコツ. 喉頭編(2), JOHNS18: 101-105, 2002. – reference: 6) 田村悦代他: Ejnell法による声門開大術に対する一考察. 日気食会報53: 1-5, 2002. – reference: 4) 久育男: 声帯外方移動術の実際. 耳鼻臨床94: 96-97, 2001. |
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| Title | Measures against problems encountered during Ejnell's technique |
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