Kashima operation is done for:
Correct Answer: Bilateral vocal cord palsy
Description: Ans. b. Bilateral vocal cord palsy (Ref: Dhingra 6/e p300)Transverse cordotomy or Kashima operation is done for bilateral vocal cord palsy.Bilateral Recurrent Laryngeal Nerve Paralysis (Bilateral Abductor Paralysis)Neuritis or surgical trauma (thyroidectomy) are the most important causes.Position of cords: As all the intrinsic muscles of larynx are paralyzed, the vocal cords lie in median or paramedianQ position due to unopposed action of cricothyroid musclesClinical Features:As both the cords lie in median or paramedian position, so there is dyspnea and stridor but voice is goodQTreatment:Emergency tracheostomy or widening the respiratory airway without a permanent tracheostomy by arytenoidectomy with suture, arytenoidopexy (fixing the arytenoid in lateral position), lateralization of vocal cord and laser cordectomy (replaced by less invasive techniques)Less Invasive Techniques for Bilateral RLN Paralysis1. Transverse cordotomy (Kashima operation)* Soft tissue at the junction of membranous cord and vocal process of arytenoid is excised laterally with laser.* This provides good airway. In case airway is still insufficient more tissue can be removed at subsequent operation.2. Partial arytenoidectomy* Medial part of arytenoid is excised with laser.* Sometimes only the vocal process of arytenoids is ablated.3. Reinnervation procedures* These have been used to innervate paralyzed posterior cricoarytenoid muscle by implanting a nerve-muscle pedicle of sternohyoid or omohyoid muscle with its nerve supply from ansa hypoglossi.* These procedures have not been very successful.4. Thyroplasty type II* It creates lateral expansion of larynx and is similar to vocal cord lateralization. Quality of voice may not be good.
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ENT
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