小儿声带沟切开加整复术麻醉方法的探讨

目的:探讨小儿声带沟切开加整复术的麻醉处理方法。方法:对28例声带沟患儿采用静脉复合麻醉加高频喷射控制呼吸(HFJV)下行声带沟切开加整复术,记录患儿在麻醉诱导前、置入支撑喉镜即刻、置入支撑喉镜后5min及退出支撑喉镜后2min时HR、SBP、SaO2的变化,并记录患儿苏醒时间。结果:本组所有患儿术野显露充分,手术进行顺利,术中无缺氧及CO2蓄积;术后苏醒迅速,停药后3~6min内患儿完全清醒,醒后无复睡及任何不适。5例患儿在安置支撑喉镜时HR明显下降,与诱导前相比,差异有统计学意义(P<0.05),静脉注射阿托品0.01mg/kg,1min后缓解,HR恢复正常;BP在置入支撑喉镜时与诱导前相比明显上升(P<0.05),2~3min后即恢复正常。结论:静脉复合麻醉加HFJV用于小儿声带沟切开加整复术,安全、可靠,是适宜的麻醉处理方法。     

声带沟的诊断及治疗

目的探讨声带沟的分型及治疗方法。方法29例声带沟患者按有无声嘶及沟的形态分为3型：Ⅰ型：生理型，11例(无声嘶)；Ⅱ型：裂线型，13例；Ⅲ型：局凹型，5例；后两种为病理型声带沟，有声嘶。对有声嘶18例进行了手术及术后嗓音训练治疗，手术方法有：①黏膜下分离自体脂肪注射术(Ⅱ型9例，Ⅲ型2例，其中1例为术式②疗效不佳再手术者)；②黏膜切开挖槽自体脂肪注射术(Ⅱ型4例、Ⅲ型1例)；③声带沟切除术(Ⅲ型4例，包括1例术式①疗效不佳再手术者)。所有患者均随访6个月以上，平均为15．3个月。结果喉镜及嗓音分析发现，13例Ⅱ型患者中10例(其中6例为黏膜下分离自体脂肪注射术，占该术式6／9；4例为黏膜切开挖槽自体脂肪注射术，占该术式4／4)，术后3个月声带沟消失，发音良好，声带振动恢复；另3例单行黏膜下分离自体脂肪注射术者，术后声带沟变浅，仍稍声嘶。5例Ⅲ型患者中3例行声带沟切除术后4～5个月声带沟消失，发音时声门闭合好，声带振动恢复；另2例先单行黏膜下分离自体脂肪注射术或黏膜切开挖槽自体脂肪术者，术后10d～3个月声带沟再现，再次手术后好转。结论对声带沟患者应分型后采用不同治疗方法，黏膜切开挖槽自体脂肪注射术对Ⅱ型治疗效果最好，声带沟切除术对Ⅲ型治疗最合适。     

声带沟的诊断及治疗

目的　探讨声带沟的分型及治疗方法。方法　 2 9例声带沟患者按有无声嘶及沟的形态分为 3型 :Ⅰ型 :生理型 ,11例 (无声嘶 ) ;Ⅱ型 :裂线型 ,13例 ;Ⅲ型 :局凹型 ,5例 ;后两种为病理型声带沟 ,有声嘶。对有声嘶 18例进行了手术及术后嗓音训练治疗 ,手术方法有 :①黏膜下分离自体脂肪注射术 (Ⅱ型 9例 ,Ⅲ型 2例 ,其中 1例为术式②疗效不佳再手术者 ) ;②黏膜切开挖槽自体脂肪注射术(Ⅱ型 4例、Ⅲ型 1例 ) ;③声带沟切除术 (Ⅲ型 4例 ,包括 1例术式①疗效不佳再手术者 )。所有患者均随访 6个月以上 ,平均为 15 3个月。结果　喉镜及嗓音分析发现 ,13例Ⅱ型患者中 10例 (其中 6例为黏膜下分离自体脂肪注射术 ,占该术式 6 /9;4例为黏膜切开挖槽自体脂肪注射术 ,占该术式 4 /4) ,术后 3个月声带沟消失 ,发音良好 ,声带振动恢复 ;另 3例单行黏膜下分离自体脂肪注射术者 ,术后声带沟变浅 ,仍稍声嘶。 5例Ⅲ型患者中 3例行声带沟切除术后 4～ 5个月声带沟消失 ,发音时声门闭合好 ,声带振动恢复 ;另 2例先单行黏膜下分离自体脂肪注射术或黏膜切开挖槽自体脂肪术者 ,术后 10d～ 3个月声带沟再现 ,再次手术后好转。结论　对声带沟患者应分型后采用不同治疗方法 ,黏膜切开挖槽自体脂肪注射术对Ⅱ型治疗效果最好 ,声     

声带沟的手术治疗

目的探讨声带沟的手术修复手段,以提高疗效.方法对经喉动态镜检查确诊的26例声带沟患者,采用喉显微外科手术加嗓音训练的综合方法治疗.其中单纯声带沟切除术9例,黏膜微瓣整复术11例,自体阔筋膜加脂肪声带注射术4例,阔筋膜声带植入术2例.术后10天进行嗓音训练,持续4～6个月.所有患者术前、术后定期行喉动态镜检查及嗓音学分析.结果术后仍有5例患者症状无明显改善,总有效率为80.8%(21/26).有效病例术后1周喉动态镜检查显示声带形态基本恢复正常,声带沟消失;术后1个月声带振动恢复.术后3个月嗓音声学分析显示声学参数较术前明显改善.行自体阔筋膜加脂肪声带注射术和阔筋膜声带植入术的6例患者中,最长观察时间28个月,声带黏膜波动良好.未出现任何并发症.结论喉显微外科手术加嗓音训练的综合治疗方法治疗声带沟效果满意.     

小儿声带沟的诊断及治疗

声带沟又称沟状声带 ,双重声带 ,声带萎缩纹等[1] ,是指膜性声带内侧缘一条与游离缘相平行的沟状凹陷 ,可位于双侧或单侧声带 ,其长度 ,深浅不一。声带沟的确认须在电子喉镜或手术显微镜下进行。我科于 1995～ 2 0 0 1年 10月开展喉显微手术 30 7例 ,其中发现并治疗小儿声带沟 2 0例 ,取得较好的效果。1.临床资料 :2 0例声带沟患儿中男 13例 ,女 7例 ;年龄 2～ 10岁 ,<5岁的 16例 ,≥ 5岁 4例 ,5岁以下占 80 %。均以声嘶、说话费力、发音易疲劳等为主要症状就诊 ,追问病史 ,均为出生后不久就有发声障碍。术前全部患者均进行录音 ,行电子喉镜…     

声带良性增生性病变行声带整复术前后的声学检测

近年 ,我科对声带良性增生性病变施行声带整复术 ,在手术前后进行嗓音声学分析检测 ,观察术后嗓音恢复情况 ,旨在对声带整复术治疗声带良性病变、恢复嗓音功能方面疗效评价提供客观依据。1　资料与方法1.1　测试对象经临床确诊的声带良性增生性病变患者共 4 0例 ,男 2 6例 ,女 14例 ,年龄 19～ 5 2岁 ,平均 36 .7± 8.7岁。其中带蒂或较小声带息肉 2 6例 (A组 ) ,单侧 18例 ,双侧 7例。广基声带息肉 (B组 ) 8例 ,单侧 2例 ,双侧 6例。声带小结 (C)组 3例 ,肥厚性喉炎 (D组 ) 3例。全部病例均在表面麻醉下行纤维喉镜检查 ,记录声带病变形态…     

自体筋膜移植填充治疗声带沟

目的探讨筋膜移植填充术在声带沟治疗中的价值及预后转归。方法23例双侧声带沟患者全麻显微镜下行声带沟瘢痕松解、筋膜移植填充手术，合并声带肌萎缩者同时行声门旁间隙脂肪注射。患者手术前、后行嗓音声学、气流动力学及频闪喉镜检查。结果4例手术失败者未进行疗效评价。19例术后6—8周患者发音开始改善，术后3个月发音改善明显。术后6个月音质趋于稳定，主、客观声学评价及气流动力学参数较术前改善明显，17例（89．5％）患者音质改善明显，声带结构及黏膜振动接近正常，声门闭合明显改善；2例患者音质改善不明显，声带形态接近正常，声门闭合改善，但黏膜振动不良。声音嘶哑主观评分与术前比较改善明显（P值均〈0．05），总评分2例患者（10．5％）提高2个等级，15例患者（79．0％）提高1个等级，2例患者（10．5％）评级无明显改变。除基频外，嗓音声学参数及最大发音时间与术前比较差异均有统计学意义（P值均〈0．01），8例（42．0％）患者声学参数达到正常范围，17例患者（89．5％）最大发音时间达到正常范围。19例患者随诊均6个月-1年，未发现筋膜吸收，其中5例患者随诊满2年，音质稳定。结论筋膜移植填充声带沟的手术可在一定程度上矫正声带固有层缺陷，改善声门闭合不良，恢复声带振动特性。     

嗓音疾病自我评估特点及影响因素

目的 探讨嗓音障碍疾病嗓音障碍自我评估特点及影响因素.方法 对1766例嗓音障碍患者及120例健康对照者行嗓音障碍指数(voice handicap index,VHI)量表评估,并对其中227例嗓音治疗后效果进行评估.结果 各种嗓音疾病患者VHI评分均明显高于对照组(z值范围8.039～17.043,P值均为0.000).不同嗓音疾病患者之间评分也有差异,量表总分自高而低依次为痉挛性发音障碍、声带麻痹、功能性发音障碍、声带沟、声带良恶性肿瘤、声带囊肿、声带任克水肿、声带息肉、声带角化与慢性喉炎、声带小结.痉挛性发音障碍组情感部分评分最高,其次为功能性发音障碍,而其他组生理部分评分均高于功能及情感评分.嗓音治疗后患者量表评分显著下降,术前术后VHI量表总评分差异有统计学意义(P值均<0.05).不同教育程度、年龄分组间量表总分差异有统计学意义(F值范围8.701～27.371,P值均为0.000),受教育程度越高,VHI评分越高;少年组VHI的各项最低,青年组最高,之后随年龄增长VHI逐渐下降.结论 VHI量表评估作为嗓音疾病严重程度及治疗效果评估的有益补充,可以从患者角度通过生理、机能及情感三方面综合评估嗓音障碍对日常生活影响及治疗前后变化,但具有一定主观性,可能受到教育程度及年龄因素影响.     

中西医结合治疗对声带息肉术后嗓音康复的疗效观察

声带息肉其主要症状为嘶哑。治疗方法主要为手术治疗，但手术摘除息肉后往往由于手术创伤，影响或延迟了发音功能的恢复。笔者采用中西医结合的治疗方法促进声带息肉摘除术后的嗓音康复，收到满意的效果，现报告如下。临床资料一、病例选择病例来源于门诊或住院，全部病例均经过纤维喉镜检查或间接喉镜检查。诊断为声带息肉。在支撑喉镜或间接喉镜下完成手术，术后经病理证实。二、一般资料本组病例中，男性38例，占65．52％，女性20例，占34．48％，男女之比为1．90：1。年龄最小者20岁，最大者59岁，平均年龄40岁。职业：本组中有工人、干…     

小儿声带结节的处理

慢性声嘶是小儿声带病变中最常见的症状，国外报道其发生率为２％～２３．４％，原因多是声带小结。报道慢性声嘶２７９例，多数患儿病程１０个月以上，其中２６９例为声带小结。其它病因包括乳突状瘤，声带麻痹，表皮样囊肿和喉室囊肿等。对声带小结的处理尚有争论，如保守疗法或选择性摘除。作者倾向于手术治疗，并认为：（１）药物治疗声嘶效果不佳；（２）患儿常受到嘲弄；（３）声嘶影响患儿日常活动和生活质量。本文报道疗效良好的有９０％，７％好转。有关解剖知识、麻醉、手术技巧以及手术显微镜的应用对提高疗效有很重要作用。总之小儿声带小结的选择性外科治疗是小儿慢性声嘶处理中的可行方法。     

Voice handicap evaluation of patients with pathologic sulcus vocalis

OBJECTIVES: The purpose of this study was to characterize the psychosocial impact of dysphonia on patients with pathologic sulcus vocalis by use of the Voice Handicap Index (VHI). METHODS: The VHI was administered to 15 patients (11 women and 4 men) with pathologic sulcus vocalis. The VHI subscale and total scores were compared with previously published data from individuals with no history of dysphonia and from patients with vocal fold scar. Additional comparisons were performed for patients with unilateral sulcus versus bilateral sulci, type II sulcus versus type III sulcus, and sulcus with concomitant vocal fold scar versus sulcus without concomitant scar. RESULTS: The VHI scores for patients with pathologic sulcus vocalis were significantly greater than those for individuals with no history of dysphonia and for patients with vocal fold scar. In addition, significantly greater VHI scores were observed for patients with sulcus vocalis with concomitant scar versus those with sulcus alone. CONCLUSIONS: These data suggest that pathologic sulcus vocalis can be a severely handicapping condition, particularly in the presence of concomitant scar.     

Fat augmentation for nonparalytic glottic insufficiency

While autogenous fat augmentation for glottic insufficiency has been used before, relatively little information is currently available on the effectiveness of fat injection in patients with nonparalytic glottic insufficiency resulting from problems such as various defects of vocal atrophy or sulcus vocalis. This paper compares retrospectively the efficiency of fat injection after surgery in patients with vocal atrophy (n = 16) and sulcus vocalis (n = 8). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation in 24 patients. The mean follow-up time was 19.5 months. Fifteen patients displayed excellent results; 1 showed some improvement; 6 experienced postprocedure failure, and 2 were not available for follow-up analysis. Perceptual rating showed significant improvement in grade, roughness and breathiness (p < 0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity, vocal fold vibration amplitude and mucosal wave excursion (p < 0.05). More improvement in vocal atrophy was observed compared with sulcus vocalis following fat injection procedures. Our research showed that middle defects improved more compared to those in the anterior and posterior area. Fat injection is an effective autogenous implant and may be considered as an option in the treatment of patients with vocal atrophy or sulcus vocalis. Although fat reabsorption was a problem, repeating the procedure could be considered.     

Sulcus vocalis in monozygotic twins

Sulcus vocalis is the presence of a groove extending along the vibratory surface of a vocal fold and may result in dysphonia. Depending on the level of severity, this condition may require treatment involving complicated surgical techniques. Cases of sulcus vocalis are classified as physiological, vergeture, or pouch type. A clear explanation of the etiology has not been established, and the currently proposed congenital origin, as described in the literature, remains controversial. This paper presents findings from monozygotic twin sisters with bilateral sulcus vocalis; these patients had similar morphologies, vibratory characteristics, and vocal quality measurements, which support the theory of a congenital etiology.     

A new surgical technique combining autologous intracordal transplantation of fat and fascia for sulcus vocalis]

We developed a new surgical technique combining autologous intracordal transplantation of fat and fascia for sulcus vocalis. Fat tissue from the abdominal wall and fascia from the postauricular region were obtained and an incision was made on the lateral portion of the vocal cord and a small pocket prepared in the lamina propria using an elevator. After inserting fat tissue into the pocket, fascia was inserted to cover the fat graft to prevent its escape from the pocket. The surgical wound was then sutured using absorbable sutures. No evidence of postoperative absorption of transplanted fat tissue was seen, and vocal function improved postoperatively. This method proved useful as surgical treatment for sulcus vocalis.     

Anatomical study of minor alterations in neonate vocal folds

IntroductionMinor structural alterations of the vocal fold cover are frequent causes of voice abnormalities. They may be difficult to diagnose, and are expressed in different manners. Cases of intracordal cysts, sulcus vocalis, mucosal bridge, and laryngeal micro-diaphragm form the group of minor structural alterations of the vocal fold cover investigated in the present study. The etiopathogenesis and epidemiology of these alterations are poorly known.ObjectiveTo evaluate the existence and anatomical characterization of minor structural alterations in the vocal folds of newborns.Methods56 larynxes excised from neonates of both genders were studied. They were examined fresh, or defrosted after conservation via freezing, under a microscope at magnifications of 25× and 40×. The vocal folds were inspected and palpated by two examiners, with the aim of finding minor structural alterations similar to those described classically, and other undetermined minor structural alterations. Larynges presenting abnormalities were submitted to histological examination.ResultsSix cases of abnormalities were found in different larynges: one (1.79%) compatible with a sulcus vocalis and five (8.93%) compatible with a laryngeal micro-diaphragm. No cases of cysts or mucosal bridges were found. The observed abnormalities had characteristics similar to those described in other age groups.ConclusionAbnormalities similar to sulcus vocalis or micro-diaphragm may be present at birth.     

Patients’ perceptions of vocal problems: results from a survey in the Tokyo area

Laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds, resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and resulting incomplete glottal closure during phonation lead to the presenting symptoms of breathy hoarseness, decrease in maximum phonation time (MPT), and vocal fatigue. These symptoms, however, have been reported from the physician’s viewpoint, not the patient’s. Furthermore, no standardized guidelines for the treatment of sulcus vocalis have been established. Because the general attitude toward sulcus vocalis appears to have become ‘It is only a vocal problem and does not significantly affect the patient’s well-being,’ knowledge of sulcus vocalis has decreased and knowledge about choices of therapy remain limited. We therefore conducted an epidemiological questionnaire survey on this pathological condition in voice clinics in seven hospitals in the Tokyo area to establish preliminary guidelines for the management of sulcus vocalis, in reference to the opinion of the patients. Here we report the summary of our preliminary study ‘a survey for sulcus vocalis’ and suggest guidelines for the management of such pathological conditions. Although these management guidelines may result in improvement in the symptoms of sulcus vocalis, patients and physicians should be aware that treatment of this condition is difficult and improvement is not guaranteed.     

声带沟的诊治进展

声带沟可导致不同程度的发声障碍，严重者对患者的生活和心理均可造成很大影响。本病病因、发病机制尚不清楚，科学的组织学分型对疾病的诊治至关重要，治疗的关键是改善声门闭合不全，恢复声带黏膜振动功能，手术是最主要的治疗方式，此外还有药物治疗、嗓音行为治疗等多种选择，但迄今为止疗效均欠佳。随着人们对声带沟的认识及研究不断深入，以及嗓音医学、组织工程技术、分子生物学、再生医学等领域的发展，未来有望对本病获得更加规范和精准的治疗，从而开辟一条全新的治疗途径。     

Fiberscopic estimation of vocal fold stiffness in vivo using the sucking method

We developed a fiberscopic device for estimating vocal fold stiffness in vivo. A small plastic tube with a hole in the side was connected to the forceps channel of the fiberscope and used as an aspiration tube under constant negative pressure. A basic experiment revealed that the maximum distance at which the vocal fold was sucked to the hole depended on the stiffness of the tissue. A preliminary study was conducted with a normal subject and four patients: one with sulcus vocalis, one with Reinke's edema, and two with carcinoma. The stiffness estimated using this method was 3 to 4 g/cm for the normal vocal fold. The stiffness for carcinoma and sulcus vocalis was significantly greater than that of normal vocal fold tissue. The stiffness of Reinke's edema did not differ markedly from that of normal tissue.     

Sulcus vocalis in laryngeal cancer: A histopathologic study

The incidental finding of sulcus vocalis in surgical specimens of patients with laryngeal cancer prompted this review. Sulcus deformities were histologically identified in 28 (48%) of 58 whole-mount coronal serial-sectioned laryngeal specimens procured from laryngeal cancer patients. The lesions were analyzed, described, and graded. A control group of 20 larynges, obtained from autopsies of patients without known laryngeal pathology, were similarly processed, and whole-mount histologic sections were studied. Four of these specimens (20%) also demonstrated sulcus deformities. In the control group, the shape and location of the sulci were similar, but the lesions were smaller than in the cancer group. The sulcus lesions revealed chronic inflammation of the subepithelial tissues with vascular ingrowth and fibrosis of the superficial lamina propria (Reinke's space); in the cancer group the sulcus was usually on the opposite vocal fold, where irritation from the tumor might be anticipated. Although the etiology of the sulci remains controversial, these findings suggest that irritation and inflammation might play a role in the pathogenesis of sulcus vocalis.