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Paresis (paralysis) of a throat


Throat paralysis (throat paresis) - disorder of motive function in the form of total absence of autokinesias owing to disturbance of an innervation of the corresponding muscles. Throat paresis - the reduction of force and (or) amplitude of autokinesias caused by disturbance of an innervation of the corresponding muscles; means temporary, up to 12 months, disturbance of mobility of one or both half of a throat.

Reasons of paresis (paralysis) of a throat:

Throat paralysis - a polietiologichny disease. It can be caused squeezed the innervating its structures or involvement of nerves in the pathological process developing in these bodies, their traumatic damage including at surgical interventions on a neck, a thorax or a skull.
Main reasons for a flaccid paralysis of a throat:
medical injury at neck and thorax operation;
prelum of a nervous trunk on an extent due to tumoral or metastatic process in a neck and a thorax, a diverticulum of a trachea or a gullet, a hematoma or infiltrate at injuries and inflammatory processes, at increase in the sizes of heart and an aortic arch (Fallo's tetrad), mitral defect, an aortic aneurysm, a hypertrophy of ventricles, dilatation of a pulmonary artery);
neuritis of inflammatory, toxic or metabolic genesis (virus, toxic (poisonings with barbiturates, organophosphates and alkaloids), gipokaltsiyemichesky, gipokaliyemichesky, diabetic, thyrocardiac).

The most frequent reason of paralysis - pathology of a thyroid gland and a medical injury at operations on it. At primary intervention the frequency of complications makes 3%, at repeated - 9%; at surgical cancer therapy of a thyroid gland - 5,7%. For 2,1% of patients paralysis is diagnosed at a presurgical stage.

Symptoms of paresis (paralysis) of a throat:

Paralysis of a throat is characterized by an immovability of one or both half of a throat. Disturbance of an innervation involves serious morfofunktsionalny changes - respiratory, protective and golosoobrazovatelny functions of a throat suffer.

Disturbances of mobility of language and soft palate, change of an articulation are characteristic of paralyzes of the central genesis.
The main complaints at unilateral paralysis of a throat:
pridykhatelny hoarseness of varying severity;
the asthma amplifying at voice loading;
pain and feeling of a foreign body on the struck party.

At a throat diplegia to the forefront there is a clinical symptomatology of its stenosis.

Degree of manifestation of clinical symptoms and morfofunktsionalny changes of a throat at paralysis depends on the provision of the paralyzed voice fold and prescription of a disease. Distinguish the median, paramedian, intermedianny and lateral provision of voice folds.

In case of unilateral paralysis of a throat a clinical picture the brightest at the lateral provision of the paralyzed voice fold. At median - symptoms can be absent, and establish the diagnosis accidentally at dispensary survey. Such paralyzes of a throat make 30%. The aphonia is characteristic of bilateral defeat with lateral fixing of voice folds. Respiratory insufficiency develops as a hyperventilation syndrome, disturbance of dividing function of a throat, especially and a type of a poperkhivaniye liquid food is possible. At a diplegia with the paramedian, intermedianny provision of voice folds note disturbance of respiratory function up to a stenosis of a throat of the third degree demanding immediate surgical treatment. It is necessary to remember that at bilateral defeat respiratory function of subjects is worse, than the patient's voice is better.

Expressiveness of clinical symptomatology depends also on prescription of a disease. In the first days disturbance of dividing function of a throat, an asthma, considerable hoarseness, feeling of a foreign body in a throat, sometimes cough is noted. Further for 4-10 days and in later terms, there occurs improvement due to partial compensation of the lost functions. However in the absence of therapy weight of clinical manifestations can amplify because of development of atrophic processes in the muscles of a throat worsening a smykaniye of voice folds over time.

Парез (паралич) гортани

Paresis (paralysis) of a throat

Treatment of paresis (paralysis) of a throat:

Carry out etiopatogenetichesky and symptomatic therapy. Treatment there begin with elimination of the reason of an immovability of a half of a throat, for example, nerve decompressions; the disintoxication and desensibilizing therapy in case of damage of a nervous trunk of inflammatory, toxic, infectious or traumatic character.

Methods of treatment of paralyzes of a throat

Etiopatogenetichesky treatment
Nerve decompression
Oncotomy, a hem, removal of an inflammation in a damage zone
The disintoxication therapy (desensibilizing, antiedematous and an antibioticotherapia)
Improvement of nerve conduction and prevention of neurodystrophic processes (трифосфаденин, vitamin complexes, acupuncture)
Improvement of synaptic conduction (neostigmin methyl sulfate)
Simulation of regeneration in a damage zone (an electrophoresis and medical and medicamentous blockade of a neostigmin methyl sulfate, a pyridoxine, a hydrocortisone)
Stimulation of nervous and muscular activity, reflexogenic zones
Mobilization of an arytenoid joint
Surgical methods (reinnervation of a throat, laringotrakheoplastik)

Symptomatic treatment
Electrostimulation of nerves and muscles of a throat
Surgical methods (tiro-, laryngoplasty, implantation surgery, tracheostomy)

Treatment purposes

The treatment purpose - recovery of mobility of elements of a throat or compensation of the lost functions (breath, swallowing and a voice).

Indications to hospitalization

In addition to those cases when surgical treatment is planned, it is desirable to hospitalize the patient on early terms of a disease for carrying out a course of the recovery and stimulating therapy.

Non-drug treatment

Use of physiotherapeutic treatment - an electrophoresis from a neostigmin methyl sulfate on a throat, zlektrostimulyation of muscles of a throat is effective.

Use outside methods immediate effect on muscles of a throat and nervous trunks, electrostimulation of reflexogenic zones diadynamic currents, an endolaryngeal zlektrostimulyation of muscles galvanic and faradic current, and also antiinflammatory therapy.

Carrying out respiratory gymnastics and fonopeliya is of great importance. The last is applied at all stages of treatment and on any terms a disease, at any etiology.

Drug treatment

Thus, at neurogenic paralysis of a voice fold irrespective of a disease etiology immediately begin the treatment directed to stimulation of regeneration of nerves on the struck party and also a cross and residual innervation of a throat. Apply the medicines improving nervous, the synaptic conduction and microcirculation which are slowing down neurodystrophic processes in muscles.

Surgical treatment

Methods of surgical treatment of unilateral paralysis of a throat:
throat reinnervation;
implantation surgery.

Surgical reinnervation of a throat is carried out by neuro, mio-, neuromuscular plastics. A big variety of clinical displays of paralysis of a throat, dependence of results of intervention on prescription of a denernation, degree of an atrophy of internal muscles of a throat, existence of the accompanying pathology of an arytenoid cartilage, various specific features of regeneration of nerve fibrils, presence of siikineziya and badly predicted throat innervation perversion with formation of hems in a zone of operation limit use of a technique in clinical practice.

From four types of a tiroplastika at paralysis of a throat apply the first (medial shift of a voice fold) and the second { lateral shift of a voice fold). At a tiroplastika of the first type, in addition to a medialization the goal a fold ogive, an arytenoid cartilage is displaced lateralno and fixed seams by means of a window in a plate of a thyroid cartilage. Advantage of this method a possibility of change of provision of a voice fold not only in horizontal, but also in the vertical plane. Use of such equipment is limited when fixing an arytenoid cartilage and an atrophy of muscles on the party of paralysis.

The most widespread method of a medialization of a voice fold at unilateral paralysis of a throat - implantation surgery. Its efficiency depends on properties of the implanted material and a way of its introduction. The implant has to have good tolerance to absorption, the thin dispersion providing easy introduction; to have hypoallergenic structure, did not cause the expressed productive fabric reaction and not to have cancerogenic properties. As an implant apply teflon, collagen, аутожир and other ways of an injection of material in the paralyzed voice fold under anesthetic at a direct mikrolaringoskopiya, under local anesthesia, endolaringealno and chreskozhno., F. Ivanchenko (1955) developed a method endolaryngeal fragmentary teflon-kollagenplastiki: enter teflon paste which makes a basis for the subsequent plastics of periblasts into deep layers.

Among a complication of implantation surgery note:
acute hypostasis of a throat.
formation of a granuloma.
migration of teflon paste in soft tissues of a neck and a thyroid gland.

Further maintaining

Treatment of paralysis of a throat stage, consecutive. In addition to drug, physiotherapeutic and surgical treatment, are shown to patients long occupation with fonopedy which purpose - formation of the correct fonatsionny breath and harmonization of themes, correction of disturbance of dividing function of a throat. Patients with a diplegia need to be observed with frequency of surveys of 1 times in 3 or 6 months depending on clinic of respiratory insufficiency.

Consultation of a foniatr for definition of opportunities of rehabilitation of the lost functions of a throat, recovery of a voice and breath in perhaps early terms is shown to patients with paralysis of a throat.

Disability term - 21 days. At a throat diplegia working ability of patients is sharply limited. At unilateral (in case of a voice profession) - working capacity restriction is possible. However at recovery of voice function these limits can be lifted.

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