Kosztyła-Hojna Bozena, Berger Greta, Zdrojkowski Maciej
Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok, Poland.
Pol Merkur Lekarski. 2017 Apr 21;42(250):173-177.
Glottal insufficiency (GI) is a cause of breathy voice that can profoundly affect quality of voice. Main causes are unilateral vocal fold paralysis or endoscopic cordectomy for the early treatment of laryngeal cancer of the glottis. The main strategy in surgical treatment is type I medialization thyroplasty according to Isshiki with the use of implants e.g. silastic, hydroxyapatite, titanium, Gore-Tex or Montgomery. Other procedures are arytenoid adduction, the injection laryngoplasty via thyrohyoid and cricothyroid approach and laryngeal reinnervation. To predict successful voice outcome and to prevent revision surgery, surgeon must choose appropriate size of the implant on the basis of subjective intraoperative visualization of the glottal closure during phonation in fibroptic laryngoscopy and by objective measurement of peroperative maximal phonation time (MPT) or direct peak subglottic pressure (DPSP) through a catheter inserted into the cricothyroid membrane. Majority of otolaryngologist recommend surgical treatment 12 months after the onset of unilateral vocal fold paralysis, before performing any permanent intervention, because some patients will have full or partial recovery of the recurrent laryngeal nerve (RLN) function and others will have adequate compensation from the intact side.
声门闭合不全（GI）是导致声音嘶哑的一个原因，可严重影响嗓音质量。主要病因是单侧声带麻痹或为早期治疗声门型喉癌而进行的内镜下声带切除术。手术治疗的主要策略是根据石木法进行I型甲状软骨内移术，并使用植入物，如硅橡胶、羟基磷灰石、钛、戈尔特斯或蒙哥马利假体。其他手术方法包括杓状软骨内收术、经甲状舌骨和环甲膜途径的注射式喉成形术以及喉再神经支配术。为预测嗓音治疗的成功结果并防止再次手术，外科医生必须在纤维喉镜检查中通过主观观察发声时声门闭合情况以及通过客观测量术中最大发声时间（MPT）或通过插入环甲膜的导管直接测量声门下峰值压力（DPSP），来选择合适尺寸的植入物。大多数耳鼻喉科医生建议在单侧声带麻痹发病12个月后，在进行任何永久性干预之前进行手术治疗，因为一些患者的喉返神经（RLN）功能会完全或部分恢复，而其他患者会从健侧获得足够的代偿。
