Slavit D H
Ames Vocal Dynamics Laboratory, Lenox Hill Hospital, New York City, USA.
Ear Nose Throat J. 1999 Jul;78(7):505-9, 512.
Surgery in the elderly requires a knowledge of the changes in the larynx that take place with aging. In the elderly larynx, there are changes in the elastin and collagen fibers within the lamina propria. There is also thinning and atrophy of the mucous membranes and atrophy of the mucous glands. Common disorders are vocal fold atrophy, sulcus vocalis, glottic incompetence, and vocal fold edema. A reduction in the number of lymphatic channels is responsible for the vocal fold edema. Vocal fold atrophy is responsible for the increase in pitch that is frequently heard in elderly men. Other common conditions in the elderly include vocal fold nodules, polyps, and Reinke's edema. The most common phonosurgical procedures performed in the elderly are vocal fold surgery for benign pathology and laryngeal structure surgery for glottic incompetence. Microsurgical techniques on benign vocal fold lesions aim to avoid injury to the transitional layer, which is rich in fibroblasts. Although the superficial layer of the lamina propria involves less fibroblastic activity, any surgical manipulation of the lamina propria can influence the vibratory properties of the vocal folds, particularly when the basement membrane zone is manipulated. The alterations in phonosurgical techniques used in the elderly are the result of histologic changes in the vocal folds and altered wound healing. Functional voice disorders often develop to compensate for the structural changes in the larynx. Correction of hyperfunctional or abnormal functional technique is as important as phonosurgical correction of vocal fold pathology.
老年患者的手术需要了解随着年龄增长喉部所发生的变化。在老年喉部，固有层内的弹性纤维和胶原纤维会发生变化。黏膜也会变薄和萎缩，黏液腺会萎缩。常见病症有声带萎缩、声带沟、声门闭合不全和声带水肿。淋巴管数量减少是导致声带水肿的原因。声带萎缩是老年男性常见音调升高的原因。老年人的其他常见病症包括声带小结、息肉和任克氏水肿。老年患者最常见的嗓音外科手术是针对良性病变的声带手术和声门闭合不全的喉部结构手术。针对良性声带病变的显微外科技术旨在避免损伤富含成纤维细胞的过渡层。虽然固有层的表层成纤维细胞活性较低，但固有层的任何手术操作都会影响声带的振动特性，尤其是在操作基底膜区时。老年患者所采用的嗓音外科技术的改变是声带组织学变化和伤口愈合改变的结果。功能性嗓音障碍常常会发展以代偿喉部的结构变化。纠正过度功能性或异常功能性技术与对声带病变进行嗓音外科矫正同样重要。
