Zusammenfassung
Für die Implantation in den menschlichen Kehlkopf stehen
zahlreiche Produkte zur Verfügung. Manche sind nur für einen
vorübergehenden Verbleib vorgesehen, wie etwa die laryngealen Stents. Im
engeren Sinn handelt es sich jedoch nur dann um ein medizinisches Implantat,
wenn a priori keine Entfernung vorgesehen ist. In der Laryngologie spielen
Implantate zur Behandlung einer glottischen Insuffizienz auf dem Boden eines
einseitigen Stimmlippenstillstands die größte Rolle. Zu diesem Zweck
stehen 2 unterschiedliche Formen von Implantaten zur Verfügung: Implantate
im eigentlichen Sinn, die aus solidem Material gefertigt sind und über
einen Zugang von außen in den paraglottischen Raum eingebracht werden, um
die stillstehende Stimmlippe in eine mehr mediane Position zu verlagern
(Thyroplastik). In dieser Übersicht werden mehrere Produkte vorgestellt,
die zu diesem Zweck entwickelt wurden. Zum anderen stehen verschiedene
Substanzen zur Verfügung, die auf endoskopischem Wege in die immobile
Stimmlippe injiziert werden können, um die glottische Insuffizienz zu
verbessern (Augmentation). Der Übergang zu den soliden Implantaten ist
fließend, weil manche dieser Substanzen korpuskulär und
hochviskös sind, sodass sie analog zu den soliden Implantaten im lateralen
paraglottischen Raum deponiert werden („injectable implants”).
Stents werden im Larynx und im laryngotrachealen Übergang in erster Linie
in der postoperativen Phase nach rekonstruktiven Eingriffen eingesetzt. Die
verschiedenen Produkte, die zu diesem Zweck auf dem Markt sind, werden
ausführlich dargestellt.
Abstract
There is a wide variety of devices and materials to be implanted
into the human larynx. Some are intended to remain only for a period of time,
like laryngeal stents. If removal is not intended the device meets the
definition for a medical implant. The majority of implants is used for the
treatment of unilateral vocal fold immobility. There a 2 types of implants
serving this purpose: Implants in a stricter sense are devices of solid
material, which are brought into the paraglottic space through a window in the
laryngeal framework (medialization thyroplasty). Several different products are
presented in this review. In contrast, there are different substances available
for endoscopic injection into the paralyzed vocal fold (injection
laryngoplasty). Since some of these substances show a corpuscular consistency
and a high viscosity they need to be deposited into the lateral paraglottic
space. Therefore, the term „injectable implants” has been coined
for these materials. The different substances available are discussed in detail
in this review.
Laryngeal stents are primarily used in the early postoperative phase
after open reconstruction of the larynx. The different devices available on the
market are described with their specific characteristics and intended use.
Schlüsselwörter
Thyroplastik - Stimmlippenaugmentation - laryngotracheale Stenose - laryngotracheale
Rekonstruktion - Atemwegsstenose - Stimmverbesserung
Key words
thyroplasty - laryngoplasty - vocal fold augmentation - laryngeal stenosis - laryngotracheal
reconstruction - laryngeal framework surgery
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Prof. Dr. med. Christian Sittel
Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische
Operationen
Klinikum Stuttgart – Katharinenhospital
Kriegsbergstraße 60
70174 Stuttgart
Email: c.sittel@klinikum-stuttgart.de
