Isshiki Nobuhiko, Sanuki Tetsuji
Kyoto Voice Surgery Center, Kyoto, Japan.
Acta Otolaryngol. 2010 Feb;130(2):275-80. doi: 10.3109/00016480903036255.
Use of the titanium bridge, both at the top and bottom corners of the incised thyroid cartilage, is essential for success. Most importantly, these procedures should be done with minimal damage to the tissues involved, using fine instruments.
Type II thyroplasty that aims at lateralization of the vocal folds for spasmodic dysphonia is a type of surgery that requires utmost surgical caution, because of the extremely delicate site for surgical intervention, critically sensitive adjustment, and difficult procedures to maintain the incised cartilages in a correct position.
By means of a postoperative questionnaire and examinations, analyses were made of the relation in each case between the detailed surgical records and the outcomes in terms of subjective complaints, vocal features, and laryngeal as well as aerodynamic findings.
It was found that surgical failures or unsatisfactory results arise most frequently from certain clear mechanical faults. The critical procedures that most affected the results included: (1) incision and separation of the thyroid cartilage at the midline; (2) adjustment of separation width for optimal voice; (3) cartilage-perichondrium separation for holding an appropriate titanium bridge; and (4) installation and fixation of titanium bridges.
在切开的甲状软骨的顶角和底角处使用钛桥对于手术成功至关重要。最重要的是，这些操作应使用精细器械，对相关组织造成最小的损伤。
针对痉挛性发声障碍旨在使声带外移的II型甲状成形术是一种手术操作需极度谨慎的手术，因为手术干预部位极其精细，调整极为敏感，且难以将切开的软骨维持在正确位置。
通过术后问卷和检查，分析了每个病例中详细手术记录与主观症状、嗓音特征、喉部及空气动力学检查结果之间的关系。
发现手术失败或效果不佳最常源于某些明确的机械性失误。对结果影响最大的关键步骤包括：（1）甲状软骨中线处的切开与分离；（2）为获得最佳嗓音调整分离宽度；（3）软骨-软骨膜分离以固定合适的钛桥；（4）钛桥的安装与固定。
