Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, U.S.A.
Laryngoscope. 2013 Nov;123(11):2780-6. doi: 10.1002/lary.24146. Epub 2013 Aug 19.
OBJECTIVES/HYPOTHESIS: The purposes of this preclinical study were to investigate histologic and rheologic outcomes of Microendoscopy of Reinke's space (MERS)-guided minithyrotomy and to assess its instrumentation.
Human cadaveric and in vivo animal study.
Three human cadaveric larynges were treated with MERS-guided placement of Radiesse VoiceGel and immediately evaluated histologically for biomaterial location. In the second part of this investigation, two scarred porcine larynges were treated with MERS-guided placement of HyStem-VF and rheologically evaluated 6 weeks later. Student t tests determined differences in viscoelastic properties of treated/untreated vocal folds. Sialendoscopes and microendoscopes were subjectively compared for their visualization capacity.
MERS imaged the subepithelial area and vocal ligament, guiding both tissue dissection and biomaterial positioning. Sialendoscopes provided adequate visualization and feature incorporated working channels. Enhanced image clarity was created in a gas-filled rather than saline-filled environment, per rater judgment. Histological analysis revealed desirable biomaterial positioning with MERS. Per rheological analysis, viscoelastic properties of the MERS-treated porcine vocal folds compared to uninjured vocal folds 6 weeks following treatment did not statistically differ.
MERS-guided laryngoplasty using sialendoscopes yielded satisfactory biomaterial positioning in the short-term and normalized rheologic tissue properties in the long-term, contributing to proof of concept for MERS in the treatment of scarring. Strengths of MERS include direct, real-time visualization of Reinke's space and an ability to manipulate surgical instruments parallel to the vocal fold edge while maintaining an intact epithelium. Future work will explore the clinical utility of MERS for addressing scarring, sulcus vocalis, and other intracordal processes.
目的/假设：本临床前研究的目的是研究 Microendoscopy of Reinke's space（MERS）引导下的微甲状腺切开术的组织学和流变学结果，并评估其仪器。
人体尸体和活体动物研究。
对 3 个人体尸体喉进行 MERS 引导下 Radiesse VoiceGel 的放置，并立即进行组织学评估以确定生物材料的位置。在本研究的第二部分，对 2 个瘢痕猪喉进行 MERS 引导下 HyStem-VF 的放置，并在 6 周后进行流变学评估。学生 t 检验确定了处理/未处理声带的粘弹性特性的差异。涎内镜和微内镜的可视化能力进行了主观比较。
MERS 成像了黏膜下区域和声带，指导组织解剖和生物材料定位。涎内镜提供了足够的可视化和功能整合的工作通道。根据评分者的判断，在充满气体而不是盐水的环境中可以创建增强的图像清晰度。MERS 组织学分析显示了理想的生物材料定位。根据流变学分析，与未经处理的声带相比，MERS 处理的猪声带的粘弹性特性在治疗后 6 周时没有统计学差异。
使用涎内镜进行 MERS 引导的喉成形术在短期内获得了令人满意的生物材料定位，并在长期内使流变学组织特性正常化，为 MERS 在治疗瘢痕方面提供了概念验证。MERS 的优势包括直接实时可视化 Reinke's 空间以及在保持完整上皮的同时平行于声带边缘操纵手术器械的能力。未来的工作将探索 MERS 在处理瘢痕、声带沟和其他声带内过程中的临床应用。
