Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
Laryngoscope. 2010 Apr;120(4):769-76. doi: 10.1002/lary.20830.
OBJECTIVES/HYPOTHESIS: Evaluate the effect of injection laryngoplasty (IL), medialization laryngoplasty (ML), and ML combined with arytenoid adduction (ML-AA) on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup.
Comparative case study using ex vivo canine larynges.
Measurements were recorded for eight excised canine larynges with simulated unilateral vocal fold paralysis before and after vocal fold injection with Cymetra. A second set of eight larynges was used to evaluate medialization laryngoplasty using a Silastic implant without and with arytenoid adduction.
IL and ML led to comparable decreases in phonation threshold flow (PTF), phonation threshold pressure (PTP), and phonation threshold power (PTW). ML-AA led to significant decreases in PTF (P = .008), PTP (P = .008), and PTW (P = .008). IL and ML led to approximately equal decreases in percent jitter and percent shimmer. ML-AA caused the greatest increase in signal-to-noise ratio. ML-AA discernibly decreased frequency (P = 0.059); a clear trend was not observed for IL or ML. IL significantly reduced mucosal wave amplitude (P = 0.002), whereas both ML and ML-AA increased it. All procedures significantly decreased glottal gap, with the most dramatic effects observed after ML-AA (P = 0.004).
ML-AA led to the greatest improvements in phonatory parameters. IL was comparable to ML aerodynamically and acoustically, but caused detrimental changes to the mucosal wave. Incremental improvements in parameters recorded from the same larynx were observed after ML and ML-AA. To ensure optimal acoustic outcome, the arytenoid must be correctly rotated. This study provides objective support for the combined ML-AA procedure in tolerant patients.
目的/假设：评估注射性喉成形术（IL）、杓状软骨内移术（ML）和杓状软骨内移术联合杓状软骨内收术（ML-AA）对切除喉模型中声学、空气动力学和黏膜波测量的影响。
使用离体犬喉进行的比较病例研究。
在使用 Cymetra 进行声带注射之前和之后，对 8 个模拟单侧声带麻痹的离体犬喉进行了测量。第二组 8 个喉用于评估不联合和联合杓状软骨内收的 Silastic 植入物的杓状软骨内移术。
IL 和 ML 导致相同程度的发声阈流（PTF）、发声阈压（PTP）和发声阈功率（PTW）降低。ML-AA 导致 PTF（P =.008）、PTP（P =.008）和 PTW（P =.008）显著降低。IL 和 ML 导致大约相同程度的微扰百分比和颤抖百分比降低。ML-AA 导致信噪比显著增加。ML-AA 明显降低频率（P = 0.059）；IL 或 ML 则没有明显的趋势。IL 显著降低黏膜波幅度（P = 0.002），而 ML 和 ML-AA 则增加了黏膜波幅度。所有手术均显著减小声门裂，其中 ML-AA 效果最明显（P = 0.004）。
ML-AA 导致发音参数的最大改善。IL 在空气动力学和声学方面与 ML 相当，但对黏膜波产生有害影响。在 ML 和 ML-AA 之后，从同一喉获得的参数记录到了递增性改善。为了确保最佳声学效果，必须正确旋转杓状软骨。本研究为耐受性好的患者联合 ML-AA 手术提供了客观支持。
