Tarnowska Czesława, Kawczyński Maciej, Just Marcin, Amernik Katarzyna, Jaworowska Ewa, Lubiński Jakub
Katedra i Klinika Otolaryngologii i Onkologii Laryngologicznej PAM.
Otolaryngol Pol. 2009 Nov-Dec;63(6):496-503. doi: 10.1016/s0030-6657(09)70168-4.
For optimalisation glottis morphology and its phonatory function after frontolateral laryngectomy (FLL) the reconstruction of larynx is made; in Clinic of Otolaryngology the most common is using epiglottis wit or without its vertical incision.
the influence of widening laryngeal resection and epiglottis incision on shape of reconstructed glottis, level and degree of phonatory closure and perceptive--acoustic characteristic of voice and speech.
39 patients (38 M and 1 F) after FLL widened of false vocal cord (n = 11), false vocal cord and part of cricoid cartilage (n = 22), whole cricoid cartilage (n = 6). Vertical incision of epiglottis was made in 31 cases. Mean age was 52 (min.-39, max.-70) years. METHODICS: videolaryngoscopic examination, subjective voice estimation using GRBAS scale, objective phonetic--acoustic voice analysis.
In videolaryngoscopic examination the most common shape of glottis was irregular triangle (n = 24), rhombus (n = 7), half--moon (n = 2), irregular (n = 6). 2 patients were using whisper. In spectrographic recordings (n = 39) only noise character of stimulation source was in 2 patients, noise--periodic with noise component present in whole acoustic spectrum in 37. F0 for single word and sentence vocalized in affirmative and interrogative form had the value of male voices and its changes during speaking were well noted. In subjective and objective estimation, the worse voice quality was after FLL widened of false vocal cord, part or whole cricoid cartilage.
为优化前外侧喉切除术后(FLL)的声门形态及其发声功能,需进行喉重建;在耳鼻喉科诊所,最常用的方法是使用会厌,可带或不带垂直切口。
扩大喉切除范围与会厌切口对重建声门形状、发声闭合水平及程度以及语音和言语的感知 - 声学特征的影响。
39例FLL患者(38例男性,1例女性),其中扩大切除假声带的有11例,扩大切除假声带及部分环状软骨的有22例,扩大切除整个环状软骨的有6例。31例患者进行了会厌垂直切口。平均年龄为52岁(最小39岁,最大70岁)。方法:视频喉镜检查,使用GRBAS量表进行主观嗓音评估,客观语音 - 声学嗓音分析。
在视频喉镜检查中,声门最常见的形状为不规则三角形(24例)、菱形(7例)、半月形(2例)、不规则形(6例)。2例患者使用耳语发声。在频谱记录(39例)中,仅2例患者的刺激源具有噪声特征,37例患者的刺激源为噪声 - 周期性且整个声谱中存在噪声成分。以肯定和疑问形式说出的单个单词和句子的F0值具有男性嗓音的特征,且在说话过程中的变化很明显。在主观和客观评估中,扩大切除假声带、部分或整个环状软骨后的嗓音质量较差。
1)94%的患者在FLL后进行会厌成形术,可为发声和社交有效的言语产生提供令人满意的形态学和生物物理学条件。2)扩大切除假声带、部分或整个环状软骨对语音和言语的感知 - 声学特征有不利影响。