Rihkanen Heikki, Reijonen Petri, Lehikoinen-Söderlund Sari, Lauri Eija-Riitta
Department of Otorhinolaryngology and Head and Neck Surgery, Helsinki University Hospital at Jorvi, Turuntie 150, 02740 Espoo, Finland.
Eur Arch Otorhinolaryngol. 2004 Apr;261(4):177-83. doi: 10.1007/s00405-003-0642-7. Epub 2003 Aug 26.
Vocal fold augmentation by injection laryngoplasty is a simple and fast procedure. The aim of this prospective study was to assess the glottal closure and the travelling mucosal wave by videostroboscopic images after autologous fascia augmentation in unilateral vocal fold paralysis (UVFP) with a special reference to objective analysis of voice. A total of 14 UVFP patients with poor voice and open glottal gap were assessed by videostroboscopy, blinded perceptual evaluation of running speech and acoustical analysis of sustained vowel. Data were collected before the procedure and at a supplementary evaluation 5-32 months (mean: 13 months) after injection of autologous fascia deep into the paralysed vocal fold. Mean age was 59 years; there were eight women and six men. Frame-by-frame video analysis revealed that before the operation 10 out of 12 had large glottal gaps without any contact between vocal folds on phonation. After the procedure seven gaps were completely closed, four partly, and two had no mucosal contact in stroboscopic examination. Maximum gap between vocal folds decreased from 7.21 units to 1.65 units (paired t-test P<0.001). Mucosal wave amplitude symmetry and phase synchrony were present in most subjects with partial closure and phase synchrony in every patient with a proper glottic closure. A panel of listeners rated voice to be significantly better ( P<0.01) ) after the procedure, and the improvement in acoustical parameters was also statistically significant ( P<0.01). There was a good correlation between objective voice analysis and videostroboscopy. Residual glottal gap was the major reason for less than optimal postoperative voice. No signs of hampered mucosal wave were noticed. Videostroboscopy and objective voice analysis suggest that augmentation by autologous fascia does not induce scar or fibrous tissue in the subepithelial space. Slight over-correction should be attempted initially in order to accomplish sufficient augmentation. This might enhance complete glottic closure and improve the outcome.
注射喉成形术进行声带增强是一种简单快捷的手术。本前瞻性研究的目的是通过频闪喉镜图像评估自体筋膜增强术后单侧声带麻痹（UVFP）患者的声门闭合和移动黏膜波，特别关注声音的客观分析。对14名声带麻痹且声音不佳、声门开放间隙的患者进行了频闪喉镜检查、连续语音的盲法感知评估和持续元音的声学分析。在将自体筋膜注入麻痹声带深部之前以及注射后5 - 32个月（平均13个月）的补充评估时收集数据。平均年龄为59岁；8名女性和6名男性。逐帧视频分析显示，术前12名患者中有10名声门间隙大，发声时声带之间无任何接触。术后，频闪喉镜检查显示7个间隙完全闭合，4个部分闭合，2个无黏膜接触。声带间最大间隙从7.21单位降至1.65单位（配对t检验P<0.001）。大多数部分闭合的受试者存在黏膜波振幅对称和相位同步，声门闭合良好的每位患者均存在相位同步。一组听众评定术后声音明显改善（P<0.01），声学参数的改善也具有统计学意义（P<0.01）。客观语音分析与频闪喉镜检查之间存在良好的相关性。残留声门间隙是术后声音未达最佳状态的主要原因。未发现黏膜波受阻的迹象。频闪喉镜检查和客观语音分析表明，自体筋膜增强不会在黏膜下间隙诱导瘢痕或纤维组织形成。最初应尝试轻微过度矫正以实现充分增强。这可能会增强声门完全闭合并改善结果。
