日本未熟児新生児学会雑誌　第26巻第1号　105～109頁（2014年）

日本未熟児新生児学会雑誌　26(1)：105-109；2014　

受付日：平成25．03．29

受理日：平成25．09．02

可逆的両側声帯麻痺を呈した新生児の1 症例：文献的考察を含めて

Spontaneous Recovery of a Neonatal Bilateral Vocal Cord Paralysis Case with a Review of Literature

済生会滋賀県病院　小児科

Department of Pediatrics, Saiseikai Shigaken Hospital

上原陽治・野澤正寛・伊藤英介

Yohji UEHARA，Masahiro NOZAWA，Eisuke ITO

Key Words：bilateral vocal cord paralysis，neonate，birth injury，spontaneous recovery

　症例は在胎41週4日，3,450gで出生した男児。分娩時および出生直後には明らかな異常は認めなかったが，出生36時間後より吸気性喘鳴と酸素飽和度の低下を認めた。喉頭ファイバーにより両側声帯麻痺と診断した。声帯麻痺は原因検索が重要であり，本症例でも精査を行ったが，声帯麻痺以外の合併奇形はなく，原因として分娩損傷の可能性が考えられた。日齢とともに症状は自然治癒し，日齢9に声帯麻痺が改善したことを喉頭ファイバーにより確認できた。奇形を伴わない両側声帯麻痺の予後は良好なことがある。また，2歳以下の声帯麻痺の文献的検索を行い，病因と改善率を検討した。声帯麻痺の予後は原因によって左右される可能性があり，気管内挿管，気管切開を含む侵襲的治療は慎重に行う必要があると考えられた。

　The patient was an infant boy born at 41 weeks and 4 days of gestation and weighed 3,450g. He was asymptomatic at birth. However, he developed stridor and oxygen desaturation 36 h after delivery. The patient was diagnosed with bilateral vocal cord paralysis using a laryngeal fiberscope. We performed this study to help determine the etiology of vocal cord paralysis. The patient presented with vocal cord paralysis without any other anomalies. Therefore, birth injury was considered the cause of vocal cord paralysis. His symptoms gradually diminished and vocal cord movement was confirmed by laryngeal fiberscopy 9 days after birth. The absence of associated anomalies in bilateral vocal cord paralysis patients might be a good prognostic factor. We then performed a literature review of children aged ≦2 years with vocal cord paralysis；the etiology and rate of improvement of these patients were investigated. In conclusion, careful determination of the invasive treatment to be used, including intratracheal intubation and tracheotomy in neonatal vocal cord paralysis, is important since the total improvement rate of children aged ≦ 2 years with vocal cord paralysis was found to be 51% according to the results of the literature review.