声带注射成形术的研究进展

声带注射成形术又称声带注射填充术,简称声带注射术.近20年来,内镜技术的发展和新材料的应用,声带注射术在治疗发声障碍方面扮演越来越重要的角色,主要用于治疗声带麻痹、声带活动受限、声带瘢痕、声带萎缩、声带沟、声带缺损等[1].     

声带注射生物材料的研究进展

声门闭合不全,是指发声时双侧声带不能完全闭合,气流不能较好地被阻塞,导致气体"漏出",表现为持续性声音嘶哑,气息声明显,高音上不去,发声无力,严重者可引起进食和饮水呛咳,误吸,甚至威胁生命.声带注射是近年常用的治疗声门闭合不全的有效方法,生物材料因其免疫排斥小、疗效确切、并发症少等优点,作为声带注射剂已逐渐取代非生物材料.     

生物材料声带注射术的研究进展

自从Arnold 1962年首次介绍了特氟隆声带注射治疗麻痹性发声困难以来，声带注射技术在不断完善，但是，由于特氟隆、液体石蜡、明胶海绵、液态硅橡胶等非生物材料注射于声带后产生各种各样的并发症，因此人们也在不断寻找理想的注射材料。自从Dedo和Roue首次将脂肪用做疤痕性声带的填充物改善发声以来，生物材料逐渐进入人们的视野并很快发展起来。     

自体脂肪声带注射术研究进展

本对自体脂肪声带注射术的历史概况，技术及方法适应证疗效及分析，组织学及ＭＲＩ评估等几何面进行了综述，并对此术式进行了展望，提出了其实用性。     

声带注射的研究

1911年 Brunings 首创声带注射甘油治疗声带麻痹。后来有些学者曾试用手术方法植入塑料、软骨及其它植入物。植入物如果不被吸收也不发生异物反应,则对病人颇有补益。1962年Brunings 的学生 Arnold 再次使用注射法,在麻痹的声带内注入聚四氟乙烯(Teflon)和等量甘油的混合物,效果满意。这种方法的安全性高、治愈率高而异物反应小。作者归纳了1962年到     

声带注射地塞米松治疗声带小结及声带息肉

自１９８１～１９９８年,我院对３００例声带小结、声带息肉的病人作地塞米松声带注射治疗,疗效令人满意,现报告如下。１ 临床资料 ３００例全部为门诊病人,男７６例,女２２４例。年龄１７～５０例,平均３２．５岁。其中１３９例为声带小结,１６１例为声带息肉（９７例为双侧）。全部病例均经药物治疗１～３个月,疗效欠佳。 治疗方法：声带注射均在门诊进行。患者取坐位。用１％丁卡因咽喉部喷雾麻醉９次（上咽、下咽、喉部各３次）,用注射器吸取地塞米松５ｍｇ（１ｍｌ）,然后间接喉镜下用自制的长５号注射针头在声带中１／３外…     

声带内移喉成形术

作者采用声带内移喉成形术治疗声带麻痹,共手术11例,男6,女5,年龄21～73岁,其中9例为一侧声带麻痹,原因有转移癌侵犯喉返神经,脑血管意外,甲状腺手术,颅底骨折和特发性病因。3例患侧     

声带注射填充术

声门闭合不良可引发不同程度的吞咽及发音障碍。自体和异体物质声带注射填充术广泛应用于各种原因所致声门闭合不良的矫治。手术的远期疗效既取决于手术方法的选择又与填充材料的生物学特性及组织相容性密切相关。     

声带注射填充术

声门闭合不良可引发不同程度的吞咽及发音障碍。自体和异体物质声带注射填充术广泛应用于各种原因所致声门闭合不良的矫治。手术的远期疗效既取决于手术方法的选择又与填充材料的生物学特性及组织相容性密切相关。     

3D打印在声带麻痹患者喉注射成形术中的应用价值

20世纪80年代初,CharlesHull发明并制造了第一台三维(3 D )打印机,当时他称之为"立体光刻设备,SLA"打印机.它是将数字信息转换成合适材料的融合或汇编,然后分层组合在一起,产生一个3D的有形物体.自那时起,3D打印技术的运用领域发生了巨大的变化,可运用于许多不同的学科,包括工程、工业制造、商业、时装和...     

声带注射填充术的临床应用

自从1911年Bruning首先在声带内注射石蜡治疗声带麻痹以来,声带注射填充术经过近百年的历史,已经发展成一项技术成熟、注射材料不断创新的声带微创手术[1-3].因其操作简捷,疗效显著,10余年来在国内得到逐步开展[4-5].     

Higher risk of superficial injection during injection laryngoplasty in women

Purpose

To review our clinical experience with percutaneous injection laryngoplasty at a single institution over a three-year period, and to specifically assess the rate of unintentional injection into the superficial lamina propria (SLP) and compare with results found in the literature.

Materials and methods

Medical records were retrospectively reviewed to identify patients who underwent office-based injection laryngoplasty (OBIL) over a three-year period. Video documentation and the written notes of the procedures were reviewed to determine the rate of inadvertent placement of injectate into the SLP. A literature review was performed to identify other reports of this complication and contributing factors.

Results

113 consecutive patients were identified who underwent OBIL in the study period. Of these, 100 patients had adequate records and follow-up available for this review. All patients underwent injection augmentation with bovine collagen using a percutaneous trans-membrane or trans-cartilaginous technique. 96 had improvement in their vocal quality and/or effort. Four patients, who were all women, had unintentional injection into the SLP with resultant no change in voice or worsened voice. All superficially placed injectates were managed conservatively.

Conclusions

Injection into the SLP is a well-recognized possible complication of OBIL. Our results suggest that this complication occurs more often in women than in men, perhaps due to differing laryngeal anatomy and size.     

Polydimethylsiloxane particles for permanent injection laryngoplasty

OBJECTIVES: Polydimethylsiloxane (PDMS) particles are a nonresorbable material that allows for permanent vocal fold augmentation. This study investigated morbidity and voice quality in patients treated for unilateral vocal fold paralysis by injection of PDMS particles. METHODS: Fourteen patients who had neurogenic unilateral vocal fold paralysis of different causes were included in this prospective study. Each patient underwent videostroboscopic assessment before and after operation. Friedrich's dysphonia index (DI), a score system combining subjective and objective parameters, was used to describe voice quality. A DI of 0 reflects a normal voice, and a DI of 3 stands for complete aphonia. The PDMS particles were injected into the paraglottic space by microlaryngoscopy under general anesthesia. RESULTS: The median follow-up was 4.1 months. There was no complication attributable to the injection of PDMS particles. The mean DI was 2.8 before operation. After the operation, voice quality improved significantly in each patient, as reflected by a mean postinjection DI of 1.4. CONCLUSIONS: Particles of PDMS provide a relatively safe and minimally invasive option for permanent vocal fold augmentation. The functional results in terms of voice improvement are comparable to those obtained with other techniques, including thyroplasty. In the European Community, PDMS particles are officially approved for use in the human larynx.     

Voice outcomes of polyacrylamide hydrogel injection laryngoplasty

OBJECTIVES: Polyacrylamide hydrogel (PAAG, Aquamid) is widely used as permanent facial tissue filler during facial plastic surgery. In this study, we examined the long-term effects and safety aspects of PAAG as a vocal fold augmentation material for patients with permanent unilateral vocal cord paralysis. STUDY DESIGN: Prospective clinical trials. METHODS: PAAG injection laryngoplasty was performed in 34 consecutive patients with permanent unilateral vocal cord paralysis. Percutaneous injection was performed under local anesthesia into the vocalis muscle using disposable 25 gauge long needles. Of the 34 patients, 16 completed acoustic, perceptual, stroboscopic, and subjective evaluations prior to the injection and at 6 and 12 months after the injection. RESULTS: Acoustic and perceptual parameters (GRBAS [Overall grade of dysphonia, Roughness, Breathiness, Aesthenia, Strain], Maximal phonation time [MPT], jitter, and shimmer) were significantly improved (P < .05) after injection and remained stable over 12 months. The grades of mucosal waves and glottic closure were also significantly improved (P < .01). The voice handicap index (VHI), as well as the visual analogue scale (VAS) of hoarseness and aspiration significantly improved over 12 months. No adverse effects were observed except for a decrease in the mucosal wave of one patient, after injection into a superficial area of the vocal fold. CONCLUSION: Based on the preliminary results of this trial, PAAG appears to be a long-lasting and safe injection material that is suitable for the treatment of glottal insufficiency caused by permanent unilateral vocal cord paralysis.     

A preliminary report on micronized AlloDerm injection laryngoplasty

OBJECTIVES: To report the preliminary data of voice and quality-of-life improvement after micronized AlloDerm injection laryngoplasty in patients with unilateral vocal cord paralysis. STUDY DESIGN: A prospective study was conducted in patients with unilateral vocal cord paralysis who underwent injection laryngoplasty with micronized AlloDerm. METHODS: Preoperative and postoperative patient evaluation consisted of videostrobolaryngoscopy, computer voice analysis, airflow, and voice handicap index (VHI) assessment. All injections were conducted with the patient under general anesthesia using the Storz injector system and a 22-gauge spinal needle. RESULTS: Fourteen patients received injection with an average amount of 0.641 mL. Twelve patients were available for evaluation. Initial results at 4 weeks (n = 12) showed significant increase in habitual phonation time from 3.84 to 6.72 seconds (P <.01) and a decrease in airflow from 0.616 to 0.295 I's (P <.01). The VHI rating improved from 62.8 to 37.5 (P <.01). Jitter and shimmer also improved significantly (P <.05). Stroboscopic findings showed complete closure of glottic gap in 10 patients with excellent return of mucosal wave on the injected side. The mucosal wave return after injection was rapid with little evidence of tissue reaction. Postoperative follow-up at 3 months (n = 8) demonstrated slight resorption of the material, but sustained excellent voice was noted in 87.5%. Minimal morbidity and tissue reaction were noted. CONCLUSIONS: Micronized AlloDerm appears to be a safe new material that is suitable for injection laryngoplasty. Long-term results are pending.