呼吸困難を伴った振り子様に腫大した高度ポリープ様声帯の1例

A large polypoid vocal cord causing dyspnea

はじめに

　声帯粘膜固有層のいわゆるReinke's spaceに主病変を有し，声帯膜様部全長にわたりびまん性の浮腫状腫脹を呈するラインケ浮腫（Reinke's edema）を，わが国ではポリープ様声帯と呼んでいる。本疾患は40歳以上の喫煙者に多く^1），慢性に経過し嗄声や声の低音化が主症状であるが^2,3），稀に呼吸困難をきたす症例^4,5）もある。今回われわれは，呼吸困難を伴った高度ポリープ様声帯の1例を経験したので，文献的考察を加えて報告する。

　We report the case of 66-year-old man with dyspnea and a giant polypoid vocal fold. The large polypoid cord moved to and fro from the larynx into the trachea synchronously with respiration, resulting in breathing difficulty. We performed emergency oropharyngeal intubation to secure the airway, followed by laryngomicrosurgery. Pendulum-like grade Ⅲ polyps of the vocal cords increase the risk of airway obstruction and require urgent attention. The optimal method to secure the airway should be disscussed with an anesthesiologist in patients in whom difficult intubation is expected because of underlying disease and/or the patient's poor general health condition.