Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Otorhinolaryngology - Head and Neck Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
Department of Otorhinolaryngology - Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Voice. 2022 Nov;36(6):868-873. doi: 10.1016/j.jvoice.2020.10.004. Epub 2020 Oct 21.
Arytenoid adduction (AA) and injection laryngoplasty (IL) are major surgical options for the treatment of unilateral vocal fold paralysis (UVFP). AA is a laryngeal framework surgery and IL is a soft-tissue augmentation procedure. Therefore, the effect of each intervention will not be substitutive but complementary to the other.
Patients who received AA and IL were enrolled (N = 43). Mean age was 60.1 ± 12.7 years. Objective and subjective voice parameters including maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), grade of dysphonia (G), and voice handicap index (VHI)-30 were collected preoperatively and 6 months postoperatively. AA and IL were sequentially performed with time interval; 28 (65.1%) patients received IL first followed by AA (IL+AA group) and 15 (34.9%) had AA followed by IL (AA+IL group). Time interval between first and second procedures was 9.9 ± 14.6 months.
MPT, jitter, shimmer, NHR, G and VHI-30 significantly improved by both first and second procedures (P < 0.001). When we evaluated IL+AA group and AA+IL group separately, the final outcomes of MPT, jitter, G, and VHI-30 between the two groups were not significantly different. When the overall effects of IL and AA were compared, MPT significantly improved with AA than with IL (P < 0.001).
In patients with unilateral vocal fold paralysis, sequential AA and IL (or IL and AA) provided additional improvement of subjective and objective voice parameters. Final outcomes of the two combined procedures resulted in similar degree of voice improvement regardless of the order of procedure.
杓状软骨内收术（AA）和注射式喉成形术（IL）是单侧声带麻痹（UVFP）的主要治疗选择。AA 是一种喉框架手术，IL 是一种软组织增强程序。因此，每种干预措施的效果不会相互替代，而是互补的。
入组接受 AA 和 IL 的患者（N=43）。平均年龄为 60.1±12.7 岁。术前和术后 6 个月收集了包括最长发声时间（MPT）、微扰、声颤、噪声与谐噪比（NHR）、嗓音障碍程度（G）和嗓音障碍指数（VHI）-30 在内的客观和主观声音参数。AA 和 IL 之间有时间间隔；28 例（65.1%）患者先接受 IL，然后接受 AA（IL+AA 组），15 例（34.9%）先接受 AA，然后接受 IL（AA+IL 组）。第一次和第二次手术之间的时间间隔为 9.9±14.6 个月。
第一次和第二次手术均可显著改善 MPT、微扰、声颤、NHR、G 和 VHI-30（P<0.001）。当我们分别评估 IL+AA 组和 AA+IL 组时，两组间 MPT、微扰、G 和 VHI-30 的最终结果无显著差异。当比较 IL 和 AA 的总体效果时，AA 比 IL 显著改善 MPT（P<0.001）。
在单侧声带麻痹患者中，序贯 AA 和 IL（或 IL 和 AA）可进一步改善主观和客观声音参数。无论手术顺序如何，两种联合手术的最终结果均导致相似程度的嗓音改善。
