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.     

改良喉成形术治疗单侧声带萎缩

目的采用一种新的喉成形手术方法,改善单侧声带萎缩患者的嗓音。方法对15例单侧声带麻痹患者局麻下采用微创手术切口行自体甲状软骨成形手术,取自体甲状软骨1cm×0.5cm置于声带前2/3的深部,使术侧声带膜部向中线内移,从而减小声门闭合时的缝隙,增加声带张力,改善发声。术中在纤维喉镜下观察手术时声带内移的情况,了解患者当时发声的改变与自我感觉。结果15例单侧声带萎缩患者术后声带闭合时的缝隙缩小,声带活动正常;动态喉镜检查基频接近正常人,自我感觉明显改善。结论自体甲状软骨成形手术可明显改善一侧声带萎缩患者的嗓音,获得满意的发声效果。     

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。     

单侧声带麻痹的外科治疗

目的比较颈袢喉返神经吻合术与声带外侧自体软骨充填术、声带脂肪注射术的疗效。方法单侧声带麻痹143例,病程6个月至12年。行颈袢与喉返神经吻合术(A组)89例：声带外侧自体软骨充填术(B组)25例;声带自体脂肪注射术(C组)29例。治疗前后以电子喉镜、频闪喉镜、声音评估和嗓音声学参数分析等评价治疗效果。结果A组术后术侧声带均内移至正中位,肌体积增大,发音时声带突明显内收,声门后裂隙消失,声带振动及黏膜波均恢复对称性,声门闭合良好：嗓音恢复正常86例。3例接近正常;声学五参数频率微拢、振幅微拢、标准化嗓音能量、基频及最长声时平均值均在正常范围内,前三项明显小于术前,后两项明显大于术前,差异均具有非常显著性。B组及C组术后声带均不同程度内移,但声带均无运动,声门后裂隙仍较明显。B、C组术后声嘶有不同程度好转,声学前三参数平均值均明显小于术前,最长声时明显大于术前,差异均具有显著性：而基频手术前后差异无显著性。B、C组的声学参数前三项均明显大于A组,而基频及最长声时明显小于A组,差异均具有显著性。B、C组间的声学五参数差异无显著性意义。结论单侧声带麻痹以神经修复术疗效最佳;声带外侧充填术及声带脂肪注射术也有治疗效果,不适合神经修复者仍可选用：脂肪注射术往往须多次注射方能维持疗效。     

特氟隆注射声带内移治疗单侧声带麻痹:定量研究

特氟隆注射声带内移可改善发声、恢复声门闭合功能、防止误吸,是治疗单侧声带麻痹的常用方法之一。该文对接受特氟隆声带内注射的单侧声带麻痹患者进行前瞻性研究,对治疗前、后发声质量的声学参数及患者的主观评估进行定量分析,评价特氟隆注射的近期疗效。８例甲状腺、支气管或食管晚期恶性肿瘤所致单侧声带麻痹患者,因其病变广泛失去治愈机会,为改善发声、提高生活质量而接受特氟隆注射治疗。采用Ｍｃ－Ｃａｆｆｒｅｙ法,经皮肤一环甲膜穿刺,用弯针头刺入声门下腔,电视喉镜监视下行声带内注射。术前行硬管喉镜和纤维内窥镜检查,记…     

杓状软骨内收术后声门结构的变化

近来人们注意到喉麻痹可以引起声门结构的复杂改变，麻痹侧声带不仅麻痹、缩短「患测产带与健侧声带的长度之比（PVF／NVF）减小〕，而且当声带处于外展位时，声带的膜部与软骨部门的夹角tVFA）减小，发声时健侧声带代偿性缩短、内收以期和患侧声带闭会发音，但声门后隙关闭不良。为改善声门结构和发声效果引入了的状软骨内收术。为验证此手术的效果该作者对11例喉麻痹，伴有声门关闭不良患者的术前和术后进行了电视喉镜观察，并将观察结果与所侧的声学和气流动力学指数，以及症状的改善情况进行了比较。符70o角Nagashima硬管内窥镜或O…     

自体脂肪声带内注射术治疗单侧声带麻痹的远期疗效观察

目的　探讨自体脂肪声带内注射术治疗单侧声带麻痹的远期疗效。方法　 2 0例单侧声带麻痹患者将取自体腹部的脂肪颗粒注射到麻痹侧声带 ,使声带隆起 ,声门闭合 ,恢复嗓音功能 ;所有病例均随访 12个月以上 ,并按术前及术后即刻、近期 (3～ 6个月 )、远期 (>12个月 )通过电子喉镜以计算机软件测得患侧与健侧声带上表面面积比为参数代表患侧声带大小变化指标 ,并用嗓音疾病评估仪进行嗓音声学测试分析。按术前嗓音声学测试结果分为轻度、中度、重度 3组 ,采用自身对照统计分析结果。结果　注射后麻痹侧声带相应体积较术前明显增大 ,但随时间推移 ,麻痹侧声带内的脂肪部分吸收 ,麻痹侧声带体积逐渐减小 ,而术后近期各组及远期中重度声嘶组测得的麻痹侧声带相应体积与术前差异有显著性 ,轻度声嘶组远期测得的麻痹侧声带相应体积与术前差异无显著性。声学测试客观分析 ,注射后较注射前嘶哑程度明显好转 ,随时间延长嘶哑程度有所下降 ,但术后近期及远期嘶哑程度接近。直接反映声门闭合程度的噪声能量在注射脂肪后较注射前明显下降 ,达到正常或接近正常 ;随时间延长噪声能量稍升高 ,但与术前差异有显著性 ,且术后近期及远期的差异无显著性。结论　自体脂肪声带内注射治疗单侧声带麻痹是可选择的有效方法 ,其远期     

动态喉镜图像定量分析技术的应用

目的探索图像定量分析技术在声带振动研究中的应用。方法应用计算机软件、分析６０例正常人和２０例单侧声带麻痹患者的动态喉镜图像。结果正常组声带振动均呈规律性,多数声门闭合完全;麻痹组声带振动均不规律,多数声门闭合不全,发声相声门最小面积（Ａｍｉｎ）麻痹组明显大于正常组,而最大面积（Ａｍａｘ）两组间无显著性差异。结论动态喉镜计算机图像分析技术可用于声带振动功能的定量分析。     

电子喉镜下脂肪注射术治疗单侧声带麻痹

目的 探讨电子喉镜监控下声带黏膜下自体脂肪注射术治疗单侧声带麻痹的疗效.方法 32例单侧声带麻痹患者,取自体脂肪颗粒在电子喉镜监控下自环甲膜穿刺,患侧声带内多角度分层次多点注射,术前、术后即刻、术后6个月、术后12个月分别测量患侧声带的表面积和声门裂隙大小,嗓音质量评估仪对嗓音进行评估.结果注射术后麻痹侧声带表面积增加,声门裂隙缩小,随时间推移,麻痹侧声带内的脂肪部分吸收,声带表面积减小,声门裂隙稍增大,术后各阶段和术前比较差异有显著性统计学意义;但术后6个月和术后12个月比较差异无显著性意义.嗓音声学测试发现,术后声门噪声能量下降,声时延长,与术前比较差异有显著性统计学意义;术后6个月和术后12个月比较,差异无显著性意义.结论电子喉镜下声带黏膜下自体脂肪注射术方法简单、方便,疗效确切,是治疗单侧声带麻痹的有效方法.     

025.利用闪光器观察■音的恢复——一侧声带麻痹硅注射疗法

一侧声带麻痹常因声门闭合不紧而嘶哑,临床上常有声门已经能够充分闭合而发音仍感粗糙者。作者为了探索除了声门闭合以外恢复发音的因素,采用患侧声带硅注射疗法。将喉闪光器的光束用二条玻璃纤维导至喉镜,再通过手术显微镜观察声带的动态,拍成照片,对注射前后声带振动的形态进行分析。     

Autogenous fat injection for vocal fold atrophy

Autogenous fat augmentation for glottic insufficiency has been used previously in patient treatment regimes. However, relatively little information is currently available regarding the effectiveness of fat injection for patients with vocal fold atrophy who have complete glottal closure (VFACGC). This paper compares, in retrospect, the efficiency of fat injection after surgery in patients with VFACGC (n=21). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation was performed on 13 patients. Mean follow-up time was 9.5 months. Fifteen patients displayed excellent results, four experienced post-procedure failure, and two were unavailable for follow-up analysis. The majority of VFACGC patients (71%) also suffered from muscular tension dysphonia (MTD) preoperatively. The procedure also resolved the MTD in half (54%) of the patients in this study. Perceptual rating showed significant improvement in grade, roughness and breathiness (P<0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity (P<0.01), vocal fold vibration amplitude and mucosal wave excursion (P<0.05). VFACGC is commonly misdiagnosed as MTD and is, therefore, unresponsive to speech therapy that is targeted to the latter. Fat injection is an effective autogenous implant and should be considered as an option in the treatment of patients with VFACGC. Although fat re-absorption was identified as a problem, repeating the procedure could be considered to minimize the effect of such.     

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.     

Bilateral vocal fold injection with autologous fat in patients with vocal fold atrophy with or without sulcus

European Archives of Oto-Rhino-Laryngology - To evaluate voice outcome after bilateral vocal fold injection with autologous fat in patients with non-paralytic glottic insufficiency due to vocal...     

Fat augmentation for glottic insufficiency

OBJECTIVES: Fat lipoinjection augmentation for glottic insufficiency has been used in patients with vocal fold paralysis. Relatively little information is available on the effectiveness of fat injection in patients with vocal atrophy, intubation trauma, and post-hemilaryngectomy defects. STUDY DESIGN: This paper retrospectively compares the efficiency of fat injection in patients with vocal cord paralysis (n = 9), vocal scar (n = 13), and vocal atrophy (n = 11). METHODS: The perceptual acoustic, phonatory function, and videolaryngostroboscopic data were evaluated before and after fat augmentation in 33 patients. RESULTS: Mean follow-up time was 9.7 months. Nineteen patients had excellent results. Three patients had no change. Five patients had late failure. Six patients were lost to follow-up. Phonatory function showed significant improvement in jitter, shimmer, noise-to-harmonic ratio, maximal phonation time, grade, asthenia, and breathiness (P < .05). Videolaryngostroboscopic rating showed significant improvement in right linearity of the vocal fold edge, amplitude of vocal fold vibration, excursion of the mucosal wave, vibratory behavior, and phase symmetry (P < .05). Anterior defects did better than posterior defects. Small vocal fold defects did better than large defects. CONCLUSIONS: Fat injection is a good autogenous implant and may be considered as an option in management of patients with vocal fold scar, defect, or atrophy. Reabsorption of fat is a problem, but the procedure may be repeated.     

Fat Augmentation Following Microsurgical Removal of the Vocal Nodules

Objectives Autogenous fat augmentation has been used as a treatment for glottic insufficiency. However, no information is available on the effectiveness of fat injection in patients with vocal nodules or recurrent vocal nodules after surgery. Study Design The retrospective study reviews the efficiency of fat injection after surgery in patients with vocal nodules (n = 18) and recurrent vocal nodules (n = 5). Methods The perceptual acoustic, phonatory function, and video laryngostroboscopic data were evaluated before and after surgery in 23 patients. Results Mean follow‐up time was 7.5 months. Nineteen patients had excellent results. Two patients had improvement, and no change was observed in two patients. Phonatory function showed significant improvement in shimmer, harmonic‐to‐noiseratio (P <.05), maximum phonation time, grade, roughness, and breathiness (P <.001). Video laryngostroboscopic rating showed significant improvement in linearity of the vocal fold edge, amplitude of vocal fold vibration, and excursion of the mucosal wave (P <.001). Less improvement was observed in recurrent vocal nodules than in nonrecurrent vocal nodules. Conclusions Fat injection is an effective autogenous implant and may be considered as an option in management of patients with vocal nodules after surgery. Recurrence of nodules is a problem, but the procedure may be repeated.     

Indications for vocal cord augmentation with collagen]

BACKGROUND: Vocal fold augmentation through an indirect laryngoscopic injection has been largely supplanted by the external approach of vocal fold medialization. Vocal fold augmentation with collagen is still of clinical importance for the temporary treatment of glottic insufficiencies. The different elimination time of certain collagen compounds in the vocal fold tissue enables individual therapeutic applications. PATIENTS AND METHODS: The collagen compounds Zyderm I and II and Zyplast were injected into the vocal fold in 37 patients with neurogenic glottic insufficiency and 2 patients with vocal fold atrophy during indirect laryngoscopy. The choice of compound was made depending on the case, prognosis, severity of the disorder, the persistence of the glottic insufficiency, and the patient's age and condition. RESULTS: Thirty-three patients showed an significant improvement of the glottic closure. However, 6 patients showed hardly any change. CONCLUSION: Collagen augmentation can be used for the temporary medialization of the vocal fold. It is a suitable method for the treatment of vocal fold paralysis a) within the neural regeneration time, and b) in patients with reduced condition and/or a short life expectancy due to severe diseases.     

自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效观察

目的 探讨自体筋膜加脂肪声带注射术治疗声门闭合不全的疗效.方法 对26例单 侧声带麻痹声门闭合不全患者全麻支撑喉镜下经口行声带内注射术,其中6例采用自体脂肪注射(A组),20例采用自体腹直肌前鞘筋膜加脂肪注射(B组).术前、术后动态喉镜检查和主客观嗓音分析评估疗效,均随访24个月.结果 两组患者术后注射物无外溢,注射侧声带形态饱满;术后3 d注射侧声带出现急性炎性反应,3个月左右消退.术后3个月A组所有患者注射侧声带回复至中线,声门闭合良好,6～24个月声门闭合稍有缝隙;B组所有患者术后6个月回复至中线,声门闭合良好,6～24个月声带形态稳定.术前嗓音声学分析:两组间基频微扰、振幅微扰、标准化噪声能量及最大发音时间差异无统计学意义(P值均＞0.05);A组术后3个月显著改善(P值均＜0.01),6及24个月较术前改善(P值＜0.05或＜0.01),但较术后3个月音质下降(P值＜0.05或＜0.01);B组术后6个月显著改善(P值均＜0.01),6、12及24个月各参数差异均无统计学意义(P值均＞0.05);术后24个月两组的基频微扰、标准化噪声能量及最大发音时间差异有统计学意义(P值＜0.05或＜0.01).B组嗓音听感知评估,总嘶哑度、气息声、发音无力程度评分降低,与术前相比差异有统计学意义(P值均＜0.01).结论 自体腹直肌前鞘筋膜加脂肪声带内注射术治疗单侧声带麻痹声门闭合不全可有效提高患者声音质量,远期效果稳定.

Abstract：

Objective To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure. Methods A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold ( group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection ( group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients. Results All patients were followed up for 24 months. On the third day after operation,there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later.In all 20 eases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant ( P ＜ 0. 01 ). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 -24 months after operation and were not changed by the length of follow-up. And in the 6 cases,videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P ＜ 0. 05 or ＜ 0. 01 ), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P ＜0. 05 or ＜0. 0l ). The significant differences were not observed between 6 and 24 months (P ＞ 0. 05 ). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months ( P ＜0. 05 or ＜ 0. 01 ). Conclusion The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.     

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.     

Clinical experience with injectable collagen for vocal fold augmentation

Injectable collagen appears to be safe and effective in treating glottic insufficiency. Fifty-four patients received vocal-fold injections of Zyderm Collagen Implant and their responses were followed for as long as 2 years. Videostroboscopy affords the best assessment of glottic function and correlates well with vocal quality. Maximum phonation time and transglottic airflow are the most sensitive measures of glottic efficiency; follow-up studies indicate that responses to treatment vary at 1 week, tend to stabilize by 3 months, and show only slight decrement over 1 year. One patient experienced a delayed hypersensitivity reaction, but it did not adversely affect his result. The use of cross-linked preparations of collagen should decrease the incidence of such responses. Treated patients were divided into diagnostic groups. Patients with bilaterally scarred vocal folds did not appear to respond optimally to collagen injection. Vocal rehabilitation was better if patients had at least one normal vocal fold. The best results occurred in patients with unilateral vocal fold paralysis and pre-existent bowing or atrophy did not affect these results. Collagen should be injected in the plane of the vocal ligament for best results; if the injection is too deep the implant is resorbed, and if too superficial, vocal-fold vibration is impaired.     

Injection laryngoplasty for management of unilateral vocal fold paralysis

PURPOSE OF REVIEW: The purpose of this review is to provide an up-to-date review of injection laryngoplasty technique and currently available injectable materials in the management of unilateral vocal fold paralysis (UVP). RECENT FINDINGS: Many new materials are currently available as substances for injection laryngoplasty. These materials have been developed along distinct of lines reasoning that address the inherent shortcomings of the previously available injectable substances, namely, poor tissue biocompatibility and poor persistence within the larynx. Accordingly, the past decade has seen heightened efforts toward developing implants with improved biocompatibility and longevity. The past year has witnessed publications reporting animal studies and, on occasion, human clinical trials involving the intralaryngeal injection of calcium hydroxyl-appetite, autologous fascia, particulate silicone and hyaluronic acid derivatives, and others, for managing glottic insufficiency. SUMMARY: In recent years, the application of injection laryngoplasty to unilateral vocal fold paralysis (UVP) has regained popularity. The technique of injection laryngoplasty has several appealing qualities including relative technical ease, low cost, and wide availability in many clinical settings. A growing number of injectable substances have been developed and tested in the clinical setting of glottic insufficiency. When used to manage unilateral vocal fold paralysis, however, injection laryngoplasty has one irrefutable shortcoming: an inability to address posterior glottic insufficiency. Therefore, while injection laryngoplasty technique becomes increasingly popular for vocal fold augmentation in cases vocal fold paresis, atrophy, and scarring, its role in the treatment of UVP should be limited to cases with an appropriate glottal defect. These techniques should be considered as part of a complimentary armamentarium with framework surgery.