Kyoto University, Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto, Japan.
Kyoto-Katsura Hospital, Department of Otolaryngology, Kyoto, Japan.
Braz J Otorhinolaryngol. 2022 Sep-Oct;88(5):767-772. doi: 10.1016/j.bjorl.2020.11.016. Epub 2020 Dec 26.
Revision framework surgeries might be required for unilateral vocal fold paralyses. However, outcomes and indications of revision surgeries have not been adequately documented. For a better understanding of indications for the procedure and to help in achieving better vocal outcomes, we performed a retrospective chart review of patients who underwent revision framework surgeries for unilateral vocal fold paralysis.
This study aimed to present clinical features of patients who underwent revision framework surgeries for the treatment of unilateral vocal fold paralysis.
Of the 149 framework surgeries performed between October 2004 and October 2019, 21 revision framework surgeries were performed in 19 patients. Self-assessments by patients using the voice handicap index-10 questionnaire, and objective aerodynamic and acoustic assessments performed pre- and post-operatively were analyzed using the Wilcoxon's signed-rank test for paired comparisons.
Undercorrection was indicated as reasons for revision surgeries in all cases. The revision techniques included type I thyroplasty, type IV thyroplasty, and arytenoid adduction, and revision surgeries were completed without any severe complication in all cases. Pre- and post-operative voice handicap index-10 scores were obtained in 12 cases, and other parameters were evaluated in 18 cases. Significant improvements were observed in voice handicap index-10 scores, maximum phonation time, mean flow rate, Current/Direct Current ratio, and pitch perturbation quotient.
Undercorrection was observed in all patients who underwent revision framework surgeries for unilateral vocal fold paralysis, and the initial assessment and planning are thought to be important in order to avoid revision surgeries. Revision surgeries were performed safely in all cases, and significantly improved vocal outcomes were observed, even after multiple procedures. Revision surgery should be considered for patients with unsatisfactory vocal functions after primary framework surgeries for unilateral vocal fold paralysis.
单侧声带麻痹可能需要进行修复框架手术。然而，修复手术的结果和适应证尚未得到充分记录。为了更好地了解手术适应证，并帮助获得更好的嗓音效果，我们对接受单侧声带麻痹修复框架手术的患者进行了回顾性图表分析。
本研究旨在介绍接受单侧声带麻痹修复框架手术的患者的临床特征。
在 2004 年 10 月至 2019 年 10 月期间进行的 149 例框架手术中，19 例患者接受了 21 例修复框架手术。通过嗓音障碍指数-10 问卷对患者进行自我评估，并对术前和术后的客观空气动力学和声学评估进行分析，采用 Wilcoxon 符号秩检验进行配对比较。
所有病例均因矫正不足而需要进行修复手术。修复技术包括 I 型甲状软骨成形术、IV 型甲状软骨成形术和杓状软骨内收术，所有病例均无严重并发症完成了修复手术。12 例患者获得了术前和术后嗓音障碍指数-10 评分，18 例患者评估了其他参数。嗓音障碍指数-10 评分、最大发音时间、平均流量、电流/直流比和音高微扰商均显著改善。
所有接受单侧声带麻痹修复框架手术的患者均存在矫正不足，因此初始评估和计划对于避免修复手术至关重要。所有病例均安全地进行了修复手术，即使在多次手术后，也观察到嗓音效果显著改善。对于单侧声带麻痹初次框架手术后嗓音功能不满意的患者，应考虑进行修复手术。
