Carbon dioxide laser enucleation of polypoid vocal cords

Polypoid vocal cords have routinely been treated by endoscopic vocal cord stripping, often-times resulting in prolonged hoarseness postoperatively. Submucosal CO₂ laser enucleation of the polypoid tissue, with preservation of a mucosal flap on the medial edge of the cord, has proved to be a valuable improvement. The surgical procedure is described and results are presented which suggest that voice quality is better earlier than is the case after vocal cord stripping.     

Benign lesions of the larynx: Should the laser be used?

The use of the carbon dioxide (CO2) laser in the treatment of patients with benign laryngeal lesions, excluding respiratory papillomatosis, has been questioned because of potential adverse thermal effects on surrounding tissue. We question whether wound healing and subsequent quality of voice would be better if the surgeon used the "cold technique" with microlaryngeal instruments. Since the advent, in 1987, of a small-spot (0.3 mm) CO2 laser micromanipulator and more precise microlaryngeal instruments, we have redefined our use of the CO2 laser for benign laryngeal lesions. Over the past 4 years, in a series of 68 consecutive patients with vocal cord nodules, polyps, polypoid changes, or granulomas, the CO2 laser was useful for mucosal micro-flap dissection techniques and for vascular lesions. Smaller pedunculated lesions, such as vocal cord nodules, were more efficiently removed with the new microlaryngeal instrumentation. The combined selective use of a microspot CO2 laser at low-power settings (1 to 3 W), with 0.1-second pulses, and with precise microlaryngeal instruments will give the best results.     

Phonatory outcome of 585 nm/pulsed-dye laser in the management of glottic leukoplakia

Objective

Vocal cord mucosectomy using pulsed-dye laser was assessed for its ability to completely remove lesions without deterioration of vocal quality in cases of vocal cord leukoplakia. To confirm the validity of a pulsed-dye laser, we retrospectively analyzed the treatment outcomes of patients who received surgery preceded by pulsed-dye laser and compared these with the outcomes of patients who received vocal cord mucosectomy using CO₂ laser.

Methods

Between February 2007 and June 2012, 36 patients were enrolled. Seventeen patients received vocal cord treatment with a CO₂ laser and 19 patients received operation with a pulsed-dye laser. To evaluate voice status, acoustic wave form analysis and electroglottography were done, and voice handicap index was measured before and after the operation.

Results

The entire lesion was removed in all patients. Compared to preoperative vocal parameters, the postoperative values for jitter were only improved in the pulsed-dye laser group. On stroboscopic findings, a diminution or lack of mucosal wave was observed in more CO₂ laser cases than pulsed-dye laser cases. Significant improvement in voice handicap index results was only observed in the pulsed-dye laser group.

Conclusion

Although long-term results with more patients are required to establish the validity of pulsed-dye laser, this study confirmed the merits of pulsed-dye laser for the en-bloc removal of vocal cord leukoplakia and improved voice outcome.     

Update: Laryngeal Reinnervation for Unilateral Vocal Cord Paralysis With the Ansa Cervicalis

Eight patients underwent ansa cervicalis anastomosis to the adductor branch of the recurrent laryngeal nerve for unilateral vocal cord paralysis. They were followed long enough (at least 1 year) to determine if the procedure was successful. All cases have been subjected to preoperative and postoperative voice recording, acoustic analysis, and videolaryngoscopy. Some of them have been subjected to stroboscopy and electromyography (EMG). Data from these cases indicate that satisfactory phonatory quality may be achieved after the procedure. The reinnervated vocal cord neither abducted nor adducted, but it presented itself in midline for precise apposition with the normal cord. Synchronous mucosal waves in both vocal cords could be observed. EMG showed that the procedure produced satisfactory reinnervation of the adductory muscles. Therefore, the authors believe that the procedure could be proposed as an alternative to Teflon injection or thyroplasty in selected cases.     

Injection and removal of Teflon for unilateral vocal cord paralysis.

For over 70 years, reinnervation attempts have been unsuccessful in restoring motion to paralyzed vocal cords, in spite of occasional claims to the contrary. Fortunately, the major defect of unilateral vocal cord paralysis, a soft and breathy voice, can be eliminated if the edge of the paralyzed vocal cord is moved to the midline. This permits the mobile vocal cord to adduct and therefore to vibrate firmly against the edge of the paralyzed vocal cord during phonation, eliminating the air leak between the vocal cords. Teflon injection of the paralyzed vocal cord does this effectively. It is accomplished most easily and reliably via indirect laryngoscopy under local anesthesia, so the effect on the voice can be monitored during the injection. Teflon can be easily removed from the vocal cord via direct laryngoscopy. The disadvantages of trying to medialize the edge of a paralyzed vocal cord via a window in the thyroid cartilage (laryngeal framework surgery) will be discussed.     

电视波纹摄影术:一种调查声带振动的高速成像技术

目的 探讨电视波纹摄影术在嗓音研究中应用的可行性。方法 使用电视波纹摄影系统观察记录声带振动。结果 电视波纹图中可观察到声带振动的频率和幅度、声门周期间的开放和关闭相、开启相和闭拢相的移动、声带上下缘的移位、粘膜波的播散，左右声带的开闭过程是否对称等重要信息。结论 此技术适用于嗓音研究。同样也适用于喉科临床。     

Effects of the autonomic nervous system function on the course of postoperative period in surgical removal of vocal cords polyps with Nd:YAG-laser

The study of the effects of autonomic nervous system (ANS) function on the course of the postoperative period after removal of the vocal cord polyps with Nd:YAG laser has shown that laryngeal operations with utilization of Nd:YAG laser accelerate normalization of structural-functional condition of the vocal cords in patients with adequate autonomic support by 25-40 days compared to those with inadequate ANS function.     

金嗓散结丸结合YAG激光治疗声带息肉疗效观察

目的 观察YAG激光治疗声带息肉后结合应用金嗓散结丸的疗效。方法 213例患者随机分为两组，其中金嗓散结丸组107例，对照组106例。YAG激光治疗结束后1月、3月进行两次随访，比较两组疗效。结果 金嗓散结丸组总有效率为99．07％，对照组总有效率为98．11％，二者差异无显著性意义，但前者1月和3月随访治愈显效率分别为89．71％和94．38％，后者分别为75．47％和77．35％，二者相比差异具有显著性意义。结论 声带息肉的YAG激光治疗术后结合运用金嗓散结丸能减轻喉部炎症反应，促进声带创面和声带外观形态的恢复，并能较好的抑制或消除部分患者YAG激光治疗后引起的喉干、喉痛和喉部灼热感等不适症状。     

Ancient schwannoma of the true vocal cord

Ancient schwannomas are benign nerve origin neoplasms that may cause difficulties in the differential diagnosis with other benign or malignant tumors. They usually occur in the head and neck region (epiglottis, arytenoepiglottic fold, false vocal cord). Involvement of the true vocal cords is extremely rare (less than 10 cases have ever been reported in the English literature--mainly in women). The present case describes a 27-year-old man who presented with a 2-year history of hoarseness. Indirect laryngoscopy showed a small polypoid mass in the middle of the left vocal cord. During microlaryngoscopy under general anesthesia, the polypoidal mass was removed and sent for histology. Immunohistochemistry and detailed histological examination revealed an ancient schwannoma. The present case in a male patient aims to increase awareness of the possibility that these tumors may also exist in the true vocal cords mimicking other more frequent lesions.     

Intubation laryngeal mask: atraumatic diagnostic tool in suspension laryngoscopy

CONCLUSION: The new technique of ILM-guided vocal cord biopsy and APC is safe, cost-effective and non-invasive. It provides excellent airway control, adequate exposure of the vocal cords and effective treatment of laryngeal bleeding. OBJECTIVE: Suspension microlaryngoscopy is a standard diagnostic procedure for vocal cord biopsy. In experienced hands failure of the procedure is extremely rare and may indicate a need for more invasive techniques. The aim of this study was to present a new technique of laryngoscopy/vocal cord biopsy and to review the relevant literature. MATERIAL AND METHODS: After induction of general anesthesia and preoxygenation an intubation laryngeal mask (ILM) was inserted. A flexible bronchoscope was passed through the ILM and an anterior lesion was identified at the vocal cord. Biopsies were taken with forceps inserted through the instrument's working channel. The procedure was performed using video-endoscopic guidance. Bleeding from the wound surface was adequately treated with argon-plasma coagulation (APC). RESULTS: Identification of the vocal cords was readily accomplished using the ILM. Only four literature reports matched our search criteria; all used the standard laryngeal mask or other instruments such as a laser or did not use the procedure for definitive therapy.     

喉返神经修复术及非喉返神经修复术治疗声带麻痹

目的 探讨喉返神经修复术及非喉返神经修复术这两种不同术式治疗声带麻痹的疗效。方法 ①单侧声带麻痹21例, 其中采用喉返神经修复术(喉返神经减压术、颈袢神经与喉返神经吻合术、颈袢神经肌肉蒂环杓侧肌移植术)15例, 采用非喉返神经修复术(声带自体脂肪注射术、自体软骨Ⅰ型甲状软骨成形术)6例;②双侧声带麻痹16例, 其中采用喉返神经修复术(喉返神经减压术、颈袢神经肌肉蒂环杓后肌移植术)6例, 采用非喉返神经修复术(声带外移术、内镜下杓状软骨切除术)10例。治疗前后以电子喉镜、频闪喉镜、声音评估等评价手术疗效。结果 ①单侧喉返神经麻痹患者中喉返神经修复组15例, 术后术侧声带活动不同程度改善, 发音时声带突明显内收, 声带振动及黏膜波均恢复对称性, 声门闭合良好, 手术前后的最大声时为(5.51±1.05)s和(12.10±1.41)s, 差异有统计学意义(P<0.01);非喉返神经修复术术后声带均不同程度内移, 声嘶症状改善, 但声带均无运动, 手术前后的最大声时为(5.47±0.45)s和(11.83±1.47)s, 差异有统计学意义(P<0.01)。神经修复组和非神经修复组术后最大声时比较, 差异无显著性意义(P>0.05);②双侧喉返神经麻痹患者中喉返神经修复术6例中, 术后呼吸困难缓解及声带外展部分恢复4例;非神经修复术10例术后呼吸困难改善;神经修复组术后拔管率为66.7%, 非神经修复组术后拔管率为100%;Fisher精确概率法比较两组术后拔管率, 差异无统计学意义(P>0.05)。结论 对于单侧声带麻痹, 喉返神经修复术及非喉返神经修复术疗效相当, 前者的远期疗效更佳。对于双侧声带麻痹, 非喉返神经修复术疗效更佳, 但喉返神经修复术不影响患者的发音功能。选择喉返神经修复术或非喉返神经修复术治疗声带麻痹, 需要医师根据自身的专业知识及技能、患者的身体状况及需求, 作出慎重的决定, 以取得可靠的疗效。     

嗓音声学分析在声带息肉术式的选择及治疗中的应用

摘要：目的比较支撑喉镜下喉显微手术与电子纤维喉镜下YAG激光手术治疗不同类型声带息肉的疗效。方法146例声带息肉患者随机分成两组,其中一组门诊行电子纤维喉镜下YAG激光手术62例,另一组支撑喉镜下显微切除术84例;采用Dr.Speech软件获得两组患者术前1 d、术后1周及术后2周的嗓音基频微扰（jitter）、振幅微扰（shimmer）及嗓音障碍严重指数（dysphonia severity index, DSI）的数值。对嗓音声学参数行统计学分析。结果声带息肉患者术前1 d的基频微扰（jitter）、振幅微扰（shimmer）均高于正常组而DSI偏低,差异均具有统计学意义（P<0.05）;两组患者术后1周及术后2周较术前明显好转;电子喉镜下YAG激光手术与支持喉镜下显微手术处理简单型声带息肉,术后同时段比较差异无明显统计学意义（P>0.05）;支持喉镜下显微手术处理复杂型声带息肉效果优于电子喉镜下YAG激光手术,同时段比较差异均具有统计学意义（P<0.05）;而术后2周与正常对照组比较差异无统计学意义（P>0.05）。结论电子喉镜与支持喉镜处理简单型声带息肉效果相当,处理复杂型声带息肉支持喉镜下显微手术效果更佳。     

Vocal cord sulcus

Vocal cord sulcus is a congenital condition consisting of a furrow on the medial edge of the vocal cord. It is most often bilateral but may be unilateral. The symptoms are a hoarse and breathy voice due to incomplete closure of the vocal cords. The present series comprises 15 patients found among 1,400 patients with voice and speech disorders. The condition is often overlooked and regarded as part of a primary functional hyperkinetic voice disorder. By close inspection the furrow can often be seen by indirect laryngoscopy. In many cases, however, microlaryngoscopy under general anaesthesia should be performed, but the furrow is only detected if a search is made for it. The condition is often found in younger patients, probably due to the fact that the sulcus is difficult to detect in older patients who have developed severe organic changes in a effort to overcome the incomplete closure of the glottis.     

Laryngeal pacing in unilateral vocal cord paralysis. An experimental study

In an attempt to remobilize a unilaterally paralyzed vocal cord, experiments were made in five adult dogs. Adduction of the paralyzed vocal cord for phonation in synchrony with the intact cord was achieved by electrical stimulation of the adductor muscles that was triggered by the signals from the cricothyroid muscle. The difference in the level of action potentials of the cricothyroid muscle between during phonation and during respiration was used for setting the threshold so as to differentiate phonation from respiration. Nearly synchronous movement of the two vocal cords thereby attained during phonation greatly improved the voice quality that was hoarse without the paced stimulation.     

单侧声带切除胸骨舌骨肌替代声带的临床应用

目的 探讨早期声带癌(TisN0M0或TiaN0M0)声带切除胸骨舌骨肌替代声带临床应用的可行性、技术操作及疗效。方法 选择7例早期声带癌(TisN0M0或TiaN0M0)施行单侧声带切除胸骨舌骨肌替代声带手术，术后通过观察替代声带活动情况、上皮化时间、声带闭合及发音情况评估手术疗效。结果 7例病例中6例发音一年左右接近正常，1例由于术中替代声带缝合不紧而出现缝合处断裂，替代声带挛缩，术后发音仍嘶哑明显。结论 胸骨舌骨肌替代声带，只要手术方法恰当，胸骨舌骨肌就能发挥良好的声带功能，改善术后发音质量，从而提高患者术后生活质量，值得推广应用。     

嗓音训练在单侧声带息肉术后嗓音恢复中的应用

目的 探讨单侧大、小声带息肉术后发声功能恢复规律和嗓音训练最佳时机.方法 选取68例武汉市第三医院耳鼻咽喉科行单侧声带息肉手术患者,根据与声带平行的息肉最大直径占同侧声带膜部1/3以下称为小声带息肉,1/3及以上为大声带息肉,分成大声带息肉组30例,小声带息肉组38例,每组随机分成嗓音训练组和禁声组;分别于术前1d,术...     

双声带楔形切除术治疗双侧声带外展麻痹

目的：探讨治疗双侧声带外展麻痹的微创外科手术方式——显微支撑喉镜下CO2激光双声带楔形切除术的临床应用价值。方法：使用显微支撑喉镜激光手术系统,治疗4例双侧声带外展麻痹患者。结果：3例经过1次手术,1例经过2次手术,随访5-36个月,患者呼吸困难完全缓解,能耐受日常生活活动;4例均对自己的声音较为满意,能进行日常的生活交流。结论：显微支撑喉镜CO2激光双侧声带楔形切除术,不需气管切开,术后喉功能恢复快,并发症少。既能解决患者通气的要求,又能保证发声的质量,本方法治疗双侧声带外展麻痹有很好的临床推广使用价值。     

Ventricular cord hyperplasias of the larynx-pathogenesis and treatment (author's transl)]

Primary hyperplasia of the ventricular cords can produce voice disturbance or can be a secondary change caused by a primary voice disorder. Primary hyperplasia, besides inflammation or tumour, arises in aging people by a metaplastic process of the glandular epithelium of the ventricular cords. These lesions are called "grandular-cystic ventricular cord hyperplasias". Secondary hyperplasias are mainly of a fibrous nature. These "fibrous-vicarious hyperplasias" arise in hyperkinetic functional voice disorders, in pareses or in some cases of extensive chronic hyperplastic or oedematous laryngitis if the vocal cords can no more be used for normal phonation. Endolaryngeal microsurgical excision from the ventricular cords followed by voice exercises enables us to treat the "ventricular cord voice" successfully within a short time.     

Phonomicrosurgical management of the disease of vocal fold]

OBJECTIVE: To find a way of reserving normal high quality phonatory function after vocal cord surgery. METHODS: Various benign lesions (vocal nodules, polyp of vocal cord, cyst of vocal cord, etc) as well as premalignant lesion and early glottic cancer were treated with minimally excision, lateral microflap, medial microflap, submucosal infusion, mucosal stripping or epithelium stripping of phonomicrosurgical techniques to achieve minimally invasion. RESULTS: The 1,044 (99.8%) patients suffering from vocal nodules, polyp or cyst and 12 Reinke's edema achieved a normal phonation within a week. The recovery of normal phonation in 20 Reinke's edema, 31 vocal cases needed 1-3 months, by mucosal stripping. The restoration of phonation on 5 papilloma, 36 early malignancy were better than trans-cervical operation. After 5 year follow-up, 3 cases of vocal cord premalignant lesions received the re-stripping operation. 32 cases of early glottic cancer remained tumor free, 5 cases relapsed and 2 cases received the re-stripping operation, and 2 cases received laryngectomy operation. CONCLUSION: The phonomicrosurgery may cure vocal disease and reserves good voice function.     

纤维喉镜下半导体激光治疗喉肿物30例

目的 探讨半导体激光治疗包括声带良性肿瘤、癌前病变等在内的喉肿物优点, 分析疗效。方法 表面麻醉, 在纤维喉镜引导下利用半导体激光切除声带或者喉室小结、息肉及声带白斑、乳头状瘤等喉肿物。术后采用口服药物或者雾化治疗消除手术水肿, 禁声1个月, 吸烟患者强制戒烟。结果 1个月后患者声嘶症状基本解决, 声带黏膜恢复良好。结论 纤维喉镜引导下半导体激光治疗喉肿物疗效好, 患者花费少, 痛苦小。