声带外侧自体脂肪注射填充术治疗声门闭合不良

目的对声带外侧自体脂肪注射填充术方法选择、预后及其影响因素进行研究,探讨声带外侧自体脂肪注射在声门闭合不良性发声障碍治疗中的价值。方法病例选择:29例声门闭合不良、发声障碍患者,27例为单侧声带麻痹(麻痹时间均超过半年),2例为声带萎缩。手术选择:全麻支撑喉镜下,应用特制Brunning高压脂肪注射器进行自体脂肪声带外侧注射。患者手术前后均行嗓音声学、气流动力学及频闪喉镜检查,确定患者发音质量及疗效。结果术后随诊10～18个月,24例患者发声明显改善,2例发声好转,3例无效。注射1个月后脂肪部分吸收,声门闭合程度及发音逐渐改善。3～6个月声带振动、声门闭合正常,发声明显改善,音质稳定,主、客观声学评价及气流动力学参数改善明显(P<0.01)。结论单侧声带麻痹或声带萎缩引起的声门闭合不良,选择声带外侧声门旁间隙脂肪注射手术,使声带膜部内移,改善声门闭合,并保留声带振动特性,患者可获得良好的发音效果。     

钛夹植入I型甲状成形手术经验

目的探讨以钛夹为植入体行甲状成形手术治疗单侧声带麻痹引起的声门关闭不全的可行性。方法以钛夹为植入体为15例单侧声带麻痹患者进行I型甲状成形手术,从而内移声带,使声门能够闭合,手术前后进行喉镜、嗓音评估比较,明确病情改善情况。结果术后定期行内镜检查发现麻痹声带得到显著内移,张力提高,声门得到闭合,嗓音障碍指数量表（VHI）发现术后总评分,功能、生理、情感评分均得到改善;手术前后评分比较,差异具有统计学意义（P<0.05）,达到了患者改善病情的目的。结论钛夹植入物容易放置,对喉内组织刺激小,所至肿胀轻,是治疗因单侧声带麻痹而出现声门闭合不全的一项安全有效的方案之一。     

自体甲状软骨植入I型甲状软骨成形术治疗单侧声带麻痹

目的 分析应用自体甲状软骨植入I型甲状软骨成形术治疗单侧声带麻痹的疗效.方法 对32例单侧声带麻痹患者于局麻下行甲状软骨板开窗,取自体甲状软骨植入(置于甲状软骨内软骨膜与甲状软骨板之间,缝合固定),使患侧声带内移;术前及术后1、3、6个月分别行电子喉镜检查、嗓音障碍指数量表(VHI)评估及嗓音声学分析,比较治疗前后结果...     

甲状腺术后单侧声带麻痹患者嗓音训练效果分析

目的 评估甲状腺术后单侧声带麻痹患者嗓音训练的疗效.方法 对24例甲状腺术后声嘶7~12个月、动态喉镜检查证实为单侧声带麻痹的女性患者(病程≤9个月15例,病程>9个月9例)进行12周嗓音训练,包括气息练习、控制膈肌练习、快速呼吸练习、放松舌根喉部肌肉练习、加强发声练习,对训练前后的嗓音质量(总嘶哑度G、VHI-10、jitter、shimmer)、空气动力学检查及动态喉镜检查结果进行分析,应用视觉模拟量表评分评价其疗效.结果 24例患者嗓音训练后自觉嗓音功能较训练前改善,根据视觉模拟量表评分,其中2例恢复正常,14例有明显改善,8例轻度改善;24例患者嗓音训练后总嘶哑度G分级、VHI-10评分、jitter、shimmer低于训练前,最长声时大于训练前,声门闭合程度较训练前改善,差异均有统计学意义(P<0.05).结论 对病程7~12个月的甲状腺术后单侧声带麻痹患者,嗓音训练通过调节发声方法可改善其嗓音功能.     

双蒂肌转入充填联合杓状软骨内移喉成形术治疗单侧声带麻痹

目的 探讨双蒂胸骨舌骨肌瓣转入声门旁联合杓状软骨内移治疗单侧声带麻痹的疗效.方法 不适合行喉返神经探查修复术的单侧声带麻痹19例.在甲状软骨板正中旁开0.5 cm裂开甲状软骨板,在杓状软骨内收固定的同时将带双蒂的胸骨舌骨肌瓣转入患侧声门旁内.治疗前后以电子喉镜、频闪喉镜、嗓音听评委主观评估、声学参数客观分析等评价治疗效果.结果 所有患侧声带膜部及声带突部术后即刻均明显内移,声带体积增大,发声时增大更为明显.术后2个月声门后裂隙消失6例,缩小13例;12个月后嗓音总嘶哑度评估:恢复正常6例,轻度声嘶12例,中度声嘶1例,较术前明显好转,采用等级资料数据秩和检验,差异具有统计学意义(z值为-4.062,P＜0.01).术后12个月的声门后裂隙、嗓音总嘶哑度与术后2个月比较无明显区别(P值均＞0.05).术后2个月及12个月声学客观指标的4个参数(基础频率、频率微扰、振幅微扰和谐噪比)平均值均明显小于术前,最长声时明显长于术前,差异均有统计学意义(P值均＜0.05).术后12个月与2个月比较上述参数差异均无统计学意义(P值均＞0.05).结论 双蒂胸骨舌骨肌充填联合杓状软骨内移喉成形术治疗不适合行喉返神经探查修复术的单侧声带麻痹患者的创伤小,无排异反应,远期效果较稳定.     

显微支撑喉镜下手术治疗沟状声带

目的探讨显微支撑喉镜下应用黏膜微瓣技术治疗沟状声带的疗效。方法对31例Ⅱ型或Ⅲ型沟状声带患者在显微支撑喉镜下切除声带沟底病变,采用黏膜微瓣技术缝合修复创面。手术前、后,应用动态喉镜观察声带形态、声门闭合情况及黏膜波变化特点,应用Dr.Speech4.0软件进行嗓音客观参数声学分析。结果所有病例均一次手术成功,无术后并发症。31例患者术后1个月发声改善明显,术后6个月音质稳定,嗓音声学参数与术前比较差异有统计学意义(P<0.01)。动态喉镜检查声带形态接近正常,声门闭合改善,黏膜波接近正常。随访1～3年,音质稳定。结论显微支撑喉镜下黏膜微瓣技术治疗沟状声带有利于声带黏膜创面愈合,减少疤痕形成,利于发声功能恢复。     

Ⅲ型甲状软骨成形术治疗男声女调

目的 观察Ⅲ型甲状软骨成形术治疗男声女调的疗效.方法 采用Ⅲ型甲状软骨成形术对12例男声女调患者进行手术治疗,术前及术后7天行喉镜及电声门图检查,比较手术前后的差异.结果 12例患者术后、嗓音均变为正常男性嗓音.纤维喉镜检查双侧声带形态、色泽正常,活动佳,声门闭合良好.电声门图示术后平均基频、接触率、闭合率较术前均显著下降(P＜0.05),基频微扰、振幅微扰、开放率较术前均显著升高(P＜0.05),噪声能量、谐噪比、信噪比手术前后差异无统计学意义(P＞0.05).12例患者随访8个月～4年均无发声异常.结论 应用Ⅲ型甲状软骨成形术矫治男声女调疗效肯定,对甲状软骨损伤小,手术易掌握.     

经环甲间隙自体阔筋膜加脂肪声带注射治疗单侧声带麻痹

目的 观察经环甲间隙自体阔筋膜加脂肪声带注射治疗周围性单侧声带麻痹的效果.方法在全麻支撑喉镜下,对12例周围性单侧声带麻痹患者经环甲间隙声带注射自体阔筋膜加脂肪,评估注射前后声带位置、声嘶改善状况及声学参数变化.结果 12例患者术后声嘶明显改善,最大声时延长.动态喉镜检查患侧声带移向正中位,声门闭合良好,3个月后注射侧声带体积保持稳定,未发现任何并发症.结论经环甲间隙自体阔筋膜加脂肪声带注射治疗单侧声带麻痹简单安全、疗效确切.     

Ⅰ型甲状软骨成形术后的喉功能恢复

单侧声带麻痹和其它原因导致的声门关闭不全患者手术治疗首选１型甲状软骨成形术。为了评估１型甲状软骨成形术后喉功能恢复情况,共对４４例患者行１型甲状软骨成形术,男性１６例,女性２８例,年龄２２～８４岁。其中２６例行左侧甲状软骨成形术,１７例行右侧甲状软骨成形术,１例行双侧声带内移术。手术过程如下：在患侧的甲状软骨中部即声带水平开一窗口,窗口的大小因人而异,平均为４×１０ｍｍ,内侧的甲状软骨膜完整保留,在电视喉镜引导下将楔形的硅胶模型植入使声带内移。在术前、术中、术后１天、１周、１月和３月分别行喉镜检…     

声带沟

声带沟是一种容易被人们忽略的先天性声带异常,其发病率甚低,既往医学文献中缺乏系统全面的报导。本文报告作者所遇1400例嗓音患者中所发现的15例声带沟,即在声带内侧缘有一条纵行细沟,或与声带等长,或仅限于一部分,可累及双侧或单侧声带。间接喉镜检查见该类患者在发音时,因声带呈弓形而声门闭合不全。发声特点为气息声与干哑声。而这种干哑气息样发声、     

Injection versus medialization laryngoplasty for the treatment of unilateral vocal fold paralysis

OBJECTIVE/HYPOTHESIS: To determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the treatment of unilateral vocal fold paralysis. STUDY DESIGN: A retrospective study of patients with unilateral vocal fold paralysis who underwent either injection or medialization laryngoplasty at the University of Arkansas for Medical Sciences between July 29, 2003 and March 8, 2005. METHODS: The data analyzed included patient characteristics and type of intervention, along with the pretreatment and posttreatment voice parameters of videostrobolaryngoscopy, perceptual analysis, and patients' subjective voice assessment. RESULTS: Nineteen patients were evaluated. The average time from intervention to posttreatment evaluation was 3 (range, 1-9) months. Improvements were demonstrated in all three voice parameters in both the injection and the medialization groups. No significant differences were found in the degree of improvement between the two groups. Videostrobolaryngoscopy and the perceptual analysis, both rated by the authors, correlated well with each other, but they both correlated poorly with the patients' subjective voice analysis. CONCLUSIONS: Injection and medialization laryngoplasty were comparable in their improvement of subjective and objective voice outcomes. Both treatment modalities should be included in the otolaryngologist's armamentarium for managing unilateral vocal fold paralysis.     

Medialization laryngoplasty with strap muscle transposition for vocal fold atrophy with or without sulcus vocalis

OBJECTIVE: Vocal fold atrophy with or without sulcus vocalis may result in a spindle-shaped glottal incompetence (SGI). Because of varying drawbacks with all existing materials (e.g., Silastic block, Teflon, fat, etc.) used for medialization or augmentation of the atrophic vocal folds, there is a need to supplant these materials with a more stable, autologous tissue to correct the SGI. STUDY DESIGN: Thirty-two patients with vocal fold atrophy underwent medialization laryngoplasty with strap muscle transposition. METHODS: Under local or general anesthesia, the thyroid lamina on the more affected side was vertically incised 5 mm off the midline. The inner perichondrium was carefully elevated from the overlying thyroid ala. Care was taken not to enter the laryngeal lumen. After dividing the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally. To accommodate the muscle flap more easily, the caudal edge of the lamina was trimmed using a small burr. A bipedicled strap muscle flap was then transposed into the space between the lamina and the paraglottic soft tissue. The thyroid cartilages were carefully sutured back in place. All patients underwent pre- and postoperative voice evaluations including laryngostroboscopy, perceptual assessment, and acoustic and aerodynamic analyses. Patients who had been followed up for more than 3 months were enrolled in this study. RESULTS: A total of 27 of the 32 patients with complete pre- and postoperative voice function measurements were included in the analysis. Vocal improvement was demonstrated in 26 of these 27 (96%) patients. No dyspnea or other major complications were noted in any patients. CONCLUSION: The results indicate that medialization laryngoplasty with strap muscle transposition is a prosthesis-free, safe, and effective technique for correcting SGI caused by vocal fold atrophy.     

Bipedicled strap muscle transposition for vocal fold deficit after laser cordectomy in early glottic cancer patients

OBJECTIVE: In treating early glottic carcinomas, the outcomes of endoscopic laser cordectomy have been proven to be valuable in local control, survival, and vocal function preservation. In some extended cases, however, laser cordectomy may leave patients with poor vocal function because of vocal fold deficit. This work assesses the vocal outcome of medialization laryngoplasty with bipedicled strap muscle transposition for vocal fold deficit resulting from laser cordectomy in early glottic cancer patients. STUDY DESIGN: A prospective clinical series. METHODS: Thirteen early glottic cancer patients who had vocal fold deficit caused by previous laser cordectomy underwent medialization laryngoplasty with bipedicled strap muscle transposition. The thyroid lamina on the cordectomy side was paramedially separated. The inner perichondrium was circumspectly raised from the overlying thyroid cartilage. After separating the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally. A bipedicled strap muscle flap was then transposed into the area between the lamina and the paraglottic soft tissue. The thyroid cartilages were carefully sutured back in position. All patients received pre- and postoperative voice assessments comprising laryngostroboscopy and vocal function studies. RESULTS: Vocal enhancement was present in 92% (12/13) of patients after medialization laryngoplasty with strap muscle transposition. The glottal closure and maximal phonation time were noticeably improved by surgery. No dyspnea or other significant complications were observed in any patients. CONCLUSION: The outcomes show that bipedicled strap muscle transposition is a prosthesis-free, safe, and valuable laryngoplastic technique for correcting glottal incompetence caused by endoscopic laser cordectomy in early glottic cancer patients.     

Long-term effects of micronized Alloderm injection for unilateral vocal fold paralysis

OBJECTIVES: Micronized Alloderm (Cymetra) is a relatively new product used for vocal fold augmentation. Previous studies evaluating possible long-term effectiveness of this product have shown mixed results. The objective of this present study is to reassess possible long-term results of Cymetra injection laryngoplasty in patients with unilateral true vocal fold paralysis. STUDY DESIGN: Retrospective review of patients with unilateral true vocal fold paralysis who received Cymetra injection laryngoplasty between March 2001 and March 2004. METHODS: Preoperative voice samples and videostroboscopic findings were compared with the most recently available postoperative data to assess efficacy of the procedure. A panel of voice experts analyzed both vocal and vibratory function in these samples. In addition, pre- and postoperative voice-related quality of life measures and patients' self-ratings of voice outcomes were compared. RESULTS: Twenty patients (7 male, 13 female; 14 with left-sided paralysis, 6 with right-sided paralysis) were identified in the study population. Cymetra injection was performed an average of 45.1 months after onset of vocal fold paralysis (range -216 months), and average follow-up postinjection was 11.2 (range -35) months. Comparing pre- and postoperative measures, voice quality (P < .0001), glottal closure (P < .0001), and degree of vocal fold bowing (P < .0001) were all improved by injection. Quality of life measures and patients' self-perceptions of vocal quality were also improved (P < .01). Fifteen (75%) patients showed long-lasting results. Eight patients showed improvement for more than 12 months after injection. CONCLUSION: Cymetra injection laryngoplasty offers improved vocal and vibratory function to patients with unilateral true vocal fold paralysis. The benefits of such medialization may be longer lasting than previously reported, and further long-term study is warranted.     

Anterior and posterior medialization (APM) thyroplasty

OBJECTIVE: In unilateral vocal fold paralysis with dysphonia, most of the paralyzed vocal folds may be medialized effectively by medialization laryngoplasty. However, if the posterior glottal gap is wide, these procedures may sometimes have a limit to medialize the posterior glottis and cannot be effective for acceptable voice quality. The objective of this study is to introduce a new surgical technique for medializing the membranous and cartilaginous portions of the paralyzed vocal fold: anterior and posterior medialization (APM) thyroplasty. METHOD: Six patients underwent APM thyroplasty. They completed preoperative and postoperative evaluation with acoustic analysis and video laryngoscopy. RESULTS: All patients satisfied their voice subjectively after surgery. The paralyzed vocal folds, membranous and cartilaginous parts, were medialized well, and the paralyzed arytenoid showed less anterior tipping postoperatively. On voice analysis all patients showed prolonged phonation times and decreased perturbations after surgery. CONCLUSION: The advantages of this procedure are to medialize the membranous and cartilaginous portions of the paralyzed vocal fold directly and to correct vertical mismatch between two vocal folds. This procedure might be especially indicated in the lateralized position of the paralyzed vocal fold but not in the higher paralyzed vocal fold compared with the normal vocal fold.     

Injection laryngoplasty according to the pathologic condition

Injection laryngoplasty is done based on the pathologic condition of the larynx. Autologous fat was harvested and endolaryngeal microsurgery conducted for injection laryngoplasty under general anesthesia. For glottic incompetence caused by bilateral atrophy of vocal fold mucosa lamina propria, autologous fat was injected into vocal fold mucosa and into the muscle just below mucosa. For glottic incompetence with a unilateral midcord gap caused by unilateral atrophy of the vocalis muscle, fat was injected into the thyroarytenoid muscle at the membranous portion of the vocal fold. In a patient with a unilateral midcord gap and a large posterior gap, autologous fat was injected into the thyroarytenoid muscle lateral to the oblong fovea of the arytenoid cartilage to arytenoid adduction. For glottic incompetence with a unilateral midcord gap and a large posterior gap, consequently afflicted with voice disorder and aspiration, fat was injected into the vocal fold, false vocal fold, aryepiglottic fold of the larynx, and the medial wall of the piriform sinus of the hypopharynx. Lipoinjection into the vocal fold, false vocal fold, and aryepiglottic fold enabled laryngeal closure. Lipoinjection into the piriform sinus lowered its capacity and residual food was reduced and pharyngeal clearance on the affected side was improved. The injected portion and the amount of injected material should be modified at injection laryngoplasty based on the pathologic condition of the larynx.     

Cricothyroid subluxation: a new innovation for enhancing the voice with laryngoplastic phonosurgery

Laryngoplastic phonosurgery has evolved to become a dominant treatment modality for paralytic dysphonia. Current surgical procedures have addressed primarily the position of the musculomembranous vocal fold and the arytenoid in the axial and vertical planes. However. dynamic range capabilities and vocal flexibility have been limited secondary to the flaccid, denervated vocal fold tissue. Therefore. a new procedure was conceived to enhance the acoustic vocal outcome from operations that reposition the vocal edge. Cricothyroid (CT) subluxation was designed as a technique to increase the distance between the cricoarytenoid joint and the insertion of the anterior commissure ligament. Cricothyroid subluxation was done without complication in 9 patients who underwent combined adduction arytenopexy and medialization laryngoplasty, and in 4 patients with medialization laryngoplasty alone. Postoperative stroboscopic assessment was done in all of the 13 patients, while complete analysis of vocal function was available in 10 of the 13 patients; this revealed improvement (as a group) on almost all objective measures over the preoperative state. All patients who underwent CT subluxation had a normal maximum frequency range (pitch variation of more than 2 octaves), as compared with 22% of a prior similar cohort of patients who did not undergo CT subluxation. All patients who underwent CT subluxation had normal glottal airflow and a normal noise-to-harmonics ratio. Cricothyroid subluxation is a relatively easily adjustable procedure that increases the length and viscoelastic tension of the denervated vocal fold. The modified biomechanical properties resulted in improved vocal outcome in all of our patients, which was most remarkable in terms of maximal range capabilities. Cricothyroid subluxation enhanced the postoperative voice of patients regardless of whether they required medialization laryngoplasty alone or whether they also required adduction arytenopexy.     

Results with collagen injection into the vocal folds for medialization

PURPOSE OF REVIEW: This review outlines the indications, surgical techniques and follow-up, with results, for current collagen use. RECENT FINDINGS: Micronized AlloDerm (Cymetra) is a presently available injectable substance made from human collagen and elastin particles. A mean follow-up of 8-10.5 months showed lasting results after injection for vocal fold immobility. Collagen injection is one possible method for treating a vocal fold scar - or sulcus -vergeture by medialization of one or both of the scarred vocal folds. Collagen injection laryngoplasty is presently the treatment of choice for presbyphonia if speech therapy is insufficient. Collagen injection for Parkinson-related dysphonia is an effective temporary method of subjectively improving voice and speech in selected patients. Laryngeal collagen injection can also permit further medialization of one or both vocal folds after medialization thyroplasty. SUMMARY: Injection laryngoplasty with micronized AlloDerm, a presently available homologous collagen, remains a suitable option for the treatment of vocal fold immobility with a moderate gap. Collagen injection is also efficient for sulcus vergetures, scars and presbyphonia, and can help in cases of Parkinson's disease. Complications are uncommon but patients must be advised that the stability of results is unpredictable. Collagen injection can be repeated and does not prevent other surgical solutions.     

Functional results after external vocal fold medialization thyroplasty with the titanium vocal fold medialization implant

OBJECTIVES/HYPOTHESIS: A persistent insufficiency of glottal closure is mostly a consequence of a unilateral vocal fold movement impairment. It can also be caused by vocal fold atrophy or scarring processes with regular bilateral respiratory vocal fold function. Because of consequential voice, breathing, and swallowing impairments, a functional surgical treatment is required. The goal of the study was to outline the functional results after medialization thyroplasty with the titanium vocal fold medialization implant according to Friedrich. METHODS: In the period of 1999 to 2001, an external vocal fold medialization using the titanium implant was performed on 28 patients (12 women and 16 men). The patients were in the age range of 19 to 84 years. Twenty-two patients had a paralysis of the left-side vocal fold, and six patients, of the right-side vocal fold. Detailed functional examinations were executed on all patients before and after the surgery: perceptive voice sound analysis according to the "roughness, breathiness, and hoarseness" method, judgment of the s/z ratio and voice dysfunction index, voice range profile measurements, videostroboscopy, and pulmonary function tests. In case of dysphagia/aspiration, videofluoroscopy of swallowing was also performed. The respective data were statistically analyzed (paired t test, Wilcoxon-test). RESULTS: All patients reported on improvement of voice, swallowing, and breathing functions postoperatively. Videostroboscopy revealed an almost complete glottal closure after surgery in all of the patients. All voice-related parameters showed a significant improvement. An increase of the laryngeal resistance by the medialization procedure could be excluded by analysis of the pulmonary function test. CONCLUSIONS: The results confirm the external medialization of the vocal folds as an adequate method in the therapy of voice, swallowing, and breathing impairment attributable to an insufficient glottal closure. The titanium implant offers, apart from good tissue tolerability, the advantage of an easy, time-saving, and individually adjustable application during the operation.     

Late displacement of a Montgomery thyroplasty implant following endotracheal intubation

OBJECTIVES: We document a late displacement of a thyroplasty implant following endotracheal intubation. METHODS: A 66-year-old man was referred to our clinic with a chief complaint of breathy dysphonia immediately following an elective inguinal hernia repair under general endotracheal anesthesia. The patient's medical history was significant for a medialization laryngoplasty with a Montgomery implant 14 years earlier. RESULTS: Examination and computed tomographic scanning of the neck confirmed displacement of the implant. The patient underwent revision medialization laryngoplasty with successful restoration of his voice quality. CONCLUSIONS: This case report illustrates a potential complication of endotracheal intubation in patients who have previously undergone vocal fold medialization procedures.