Parker Noah P, Barbu Anca M, Hillman Robert E, Zeitels Steven M, Burns James A
Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
Otolaryngol Head Neck Surg. 2015 Oct;153(4):593-8. doi: 10.1177/0194599815585091. Epub 2015 May 12.
To identify patterns of failure following transcervical medialization laryngoplasty for unilateral vocal fold paralysis and describe indications and revision techniques for optimal vocal outcomes.
Case series with chart review.
Tertiary care center.
Thirty-nine consecutive patients between January 2005 and April 2014 undergoing transcervical revision of failed primary medialization laryngoplasty were identified. Demographics, etiology, stroboscopic assessment, and surgical techniques were recorded. Patient self-assessment using the Voice-Related Quality-of-Life (VRQOL) questionnaire and objective acoustic and aerodynamic assessments performed pre- and postoperatively were analyzed using t tests for paired comparisons.
Thirty-nine patients underwent 48 transcervical revision surgeries. Median follow-up was 14.6 months from time of final revision surgery. Indications included anterior glottic incompetence (38/48, 79%), posterior glottic incompetence (20/48, 42%), glottic overclosure (8/48, 17%), and/or decreased phonatory pliability (12/48, 25%). A combination of findings was present in 21 (44%) surgeries. Revision techniques included either anterior augmentation, arytenopexy, and cricothyroid subluxation (alone or in combination) in 46 of 48 (96%) patients or partial implant removal alone in 2 patients. Seven patients (18%) required multiple revisions. A complete set of voice parameters was available for 22 patients, and statistically significant improvements included VRQOL scores, fundamental frequency in females, jitter, noise-to-harmonic ratio, and mean airflow rate.
Patterns of failure in patients with suboptimal phonatory function after transcervical medialization laryngoplasty included persistent glottic incompetence, glottic overclosure, and decreased vocal fold pliability. Revision transcervical medialization surgery, guided by individualized consideration of vocal fold position and surface pliability, can improve phonatory outcomes.
确定经颈内侧化喉成形术治疗单侧声带麻痹后的失败模式，并描述为实现最佳发声效果的适应证及翻修技术。
回顾图表的病例系列研究。
三级医疗中心。
确定了2005年1月至2014年4月期间连续39例接受初次内侧化喉成形术失败后经颈翻修手术的患者。记录人口统计学资料、病因、频闪喉镜评估结果及手术技术。使用与嗓音相关的生活质量（VRQOL）问卷进行患者自我评估，并对术前和术后进行的客观声学和空气动力学评估采用配对t检验进行分析。
39例患者接受了48次经颈翻修手术。末次翻修手术后的中位随访时间为14.6个月。适应证包括声门前部闭合不全（38/48，79%）、声门后部闭合不全（20/48，42%）、声门过度闭合（8/48，17%）和/或发声柔韧性降低（12/48，25%）。21例（44%）手术存在多种表现。翻修技术包括48例患者中的46例（96%）单独或联合采用前部填充、杓状软骨固定和环甲关节半脱位，2例患者单独进行部分植入物取出。7例患者（18%）需要多次翻修。22例患者可获得完整的嗓音参数，统计学上有显著改善的指标包括VRQOL评分、女性的基频、抖动、噪声谐波比和平均气流量。
经颈内侧化喉成形术后发声功能欠佳患者的失败模式包括持续的声门闭合不全、声门过度闭合和声带柔韧性降低。根据对声带位置和表面柔韧性的个体化考虑进行经颈内侧化翻修手术，可改善发声效果。
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