Hesaka H, Miyano R, Matsui M, Kamide Y, Moriyama H
Department of Otolaryngology, Jikei University School of Medicine, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 1994 May;97(5):847-54. doi: 10.3950/jibiinkoka.97.847.
Intracordal injection therapy is a surgical therapeutic modality for glottic incompetence caused by unilateral laryngeal paralysis. Atelocollagen, which has recently been attracting attention as a material for use in intracordal injection therapy that supplants silicon, was initially claimed and expected, by virtue of its salient biophysical properties, not to cause impaired wave-motion of the vocal mucosa when injected into the submucosa. Unfortunately, however, our attempt to use this material for the same purpose proved disappointingly unsuccessful, with vocal sounds produced thereafter being metallic, vocal folds becoming tense and consequently transforming the site into a muscular coat of vocal muscles. During the past 3 years, we at the Department of Otolaryngology of the Jikei University School of Medicine, have performed intracordal injection therapy with atelocollagen on 20 patients diagnosed as having unilateral laryngeal paralysis under local anesthesia using a flexible fiberscope and a stroboscope under a video monitoring system. Comparisons were made of the voice before and after injection in 6 patients receiving submucosal injection and 14 given intramuscular injection of the material. In some autopsied patients, histological findings of the treated vocal cords were scrutinized and problems regarding atelocollagen injection were investigated. Judging from pathological findings of the vocal cords after atelocollagen injection and the clinical results of this therapeutic procedure, it seems most appropriate to inject this plastic material into the vocal muscles. This will prevent atelocollagen diffusion and maintain unimpaired wave-motion of the vocal mucosa, thus resulting in an acceptable voice quality.
声带内注射疗法是一种针对单侧喉麻痹所致声门功能不全的外科治疗方式。去端胶原蛋白作为一种有望替代硅用于声带内注射疗法的材料，近来备受关注。最初，因其显著的生物物理特性，人们认为将其注入黏膜下层时不会导致声带黏膜波动受损。然而，遗憾的是，我们将这种材料用于相同目的的尝试却令人失望地失败了，此后产生的声音带有金属质感，声带变得紧张，进而使该部位转变为声带肌肉的肌层。在过去3年里，东京慈惠会医科大学耳鼻咽喉科对20例诊断为单侧喉麻痹的患者，在局部麻醉下使用可弯曲纤维喉镜和频闪喉镜，并在视频监测系统下进行了去端胶原蛋白声带内注射治疗。对6例接受黏膜下注射和14例接受肌肉注射该材料的患者注射前后的声音进行了比较。在一些尸检患者中，仔细检查了治疗后声带的组织学 findings，并研究了与去端胶原蛋白注射有关的问题。从去端胶原蛋白注射后声带的病理 findings 以及该治疗方法的临床结果判断，将这种可塑性材料注入声带肌肉似乎最为合适。这将防止去端胶原蛋白扩散，并保持声带黏膜不受损的波动，从而产生可接受的声音质量。
