Department of Surgery, Harvard Medical School, Boston, Massachusetts.
Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Laryngoscope. 2020 Aug;130(8):1980-1988. doi: 10.1002/lary.28333. Epub 2019 Oct 11.
OBJECTIVES/HYPOTHESIS: We previously developed an instrument called the Aerodynamic Vocal Fold Driver (AVFD) for intraoperative magnified assessment of vocal fold (VF) vibration during microlaryngoscopy under general anesthesia. Excised larynx testing showed that the AVFD could provide useful information about the vibratory characteristics of each VF independently. The present investigation expands those findings by testing new iterations of the AVFD during microlaryngoscopy in the canine model.
Animal model.
The AVFD is a handheld instrument that is positioned to contact the phonatory mucosa of either VF during microlaryngoscopy. Airflow delivered through the AVFD shaft to the subglottis drives the VF into phonation-like vibration, which enables magnified observation of mucosal-wave function with stroboscopy or high-speed video. AVFD-driven phonation was tested intraoperatively (n = 26 VFs) using either the original instrument design or smaller and larger versions three-dimensionally printed from a medical grade polymer. A high-fidelity pressure sensor embedded within the AVFD measured VF contact pressure. Characteristics of individual VF phonation were compared with typical two-fold phonation and compared for VFs scarred by electrocautery (n = 4) versus controls (n = 22).
Phonation was successful in all 26 VFs, even when scar prevented conventional bilateral phonation. The 15-mm-wide AVFD fits best within the anteroposterior dimension of the musculo-membranous VF, and VF contact pressure correlated with acoustic output, driving pressures, and visible modes of vibration.
The AVFD can reveal magnified vibratory characteristics of individual VFs during microlaryngoscopy (e.g., without needing patient participation), potentially providing information that is not apparent or available during conventional awake phonation, which might facilitate phonosurgical decision making.
NA Laryngoscope, 130: 1980-1988, 2020.
目的/假设：我们之前开发了一种名为气动声带驱动器（AVFD）的仪器，用于在全身麻醉下进行显微镜检查时对声带（VF）的振动进行术中放大评估。切除喉测试表明，AVFD 可以独立提供有关每个 VF 振动特性的有用信息。本研究通过在犬模型的显微镜检查中测试 AVFD 的新迭代来扩展这些发现。
动物模型。
AVFD 是一种手持仪器，在显微镜检查期间将其定位以接触任一侧的发音黏膜。通过 AVFD 轴输送到声门下的气流驱动 VF 进入类似发声的振动，从而能够通过频闪镜或高速视频放大观察黏膜波功能。使用原始仪器设计或通过从医用级聚合物三维打印的较小和较大版本，在术中（n = 26 个 VF）测试 AVFD 驱动的发声。嵌入在 AVFD 中的高保真压力传感器测量 VF 接触压力。将单个 VF 发声的特征与典型的二倍发声进行比较，并将电烙瘢痕的 VF（n = 4）与对照（n = 22）进行比较。
所有 26 个 VF 的发声均成功，即使瘢痕妨碍了常规的双侧发声。15mm 宽的 AVFD 最适合在肌膜性 VF 的前后维度内，VF 接触压力与声学输出，驱动压力和可见振动模式相关。
AVFD 可以在显微镜检查期间揭示单个 VF 的放大振动特性（例如，无需患者参与），这可能提供在常规清醒发声期间不明显或不可用的信息，从而有助于语音手术决策。
无喉镜，130：1980-1988，2020。
