Hong K H, Kim J H, Kim H K
Department of Otolaryngology-Head and Neck Surgery, Chonbuk National University, Medical School, Chonju, Chonbuk 560-712, Korea.
Laryngoscope. 2001 Aug;111(8):1406-12. doi: 10.1097/00005537-200108000-00017.
In unilateral vocal fold paralysis with dysphonia, most of the paralyzed vocal folds may be medialized effectively by medialization laryngoplasty. However, if the posterior glottal gap is wide, these procedures may sometimes have a limit to medialize the posterior glottis and cannot be effective for acceptable voice quality. The objective of this study is to introduce a new surgical technique for medializing the membranous and cartilaginous portions of the paralyzed vocal fold: anterior and posterior medialization (APM) thyroplasty.
Six patients underwent APM thyroplasty. They completed preoperative and postoperative evaluation with acoustic analysis and video laryngoscopy.
All patients satisfied their voice subjectively after surgery. The paralyzed vocal folds, membranous and cartilaginous parts, were medialized well, and the paralyzed arytenoid showed less anterior tipping postoperatively. On voice analysis all patients showed prolonged phonation times and decreased perturbations after surgery.
The advantages of this procedure are to medialize the membranous and cartilaginous portions of the paralyzed vocal fold directly and to correct vertical mismatch between two vocal folds. This procedure might be especially indicated in the lateralized position of the paralyzed vocal fold but not in the higher paralyzed vocal fold compared with the normal vocal fold.
在单侧声带麻痹伴发音障碍的病例中，大多数麻痹的声带可通过喉内移术有效地内移。然而，如果声门后间隙较宽，这些手术有时在使声门后部内移方面可能存在局限性，并且对于获得可接受的嗓音质量可能无效。本研究的目的是介绍一种使麻痹声带的膜部和软骨部内移的新手术技术：前后内移（APM）甲状成形术。
6例患者接受了APM甲状成形术。他们完成了术前和术后的声学分析及电子喉镜评估。
所有患者术后对嗓音主观上感到满意。麻痹的声带，其膜部和软骨部均良好地内移，且术后麻痹的杓状软骨向前倾翻程度减轻。在嗓音分析方面，所有患者术后发声时间延长且嗓音扰动减少。
该手术的优点是直接使麻痹声带的膜部和软骨部内移，并纠正两侧声带之间的垂直不协调。该手术可能特别适用于麻痹声带处于外展位的情况，但不适用于与正常声带相比处于较高位置的麻痹声带。
