Lawson G, Remacle M, Hamoir M, Jamart J
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Louvain, Belgium.
J Voice. 1996 Sep;10(3):314-9. doi: 10.1016/s0892-1997(96)80013-0.
We report vocal and respiratory results following endoscopic CO2 laser therapy for bilateral vocal fold immobility in adduction. Two techniques were used: posterior cordectomy (PC) and subtotal arytenoidectomy (SA). Respiratory improvement was demonstrated by the peak expiratory flow/peak inspiratory flow ratio (PEF/PIF, normal = 1), which was less than 2 for 83% of patients following PC and for 81% following SA. As for vocal results, there were no significant quantitative differences between the two techniques. Mean maximum phonation time (/a/) was 6.8 +/- 2.6 s after SA and 7.8 +/- 1.6 s following PC. The phonation quotient was 288 +/- 116 ml/s after SA and 304 +/- 92 ml/s after PC. Mean vocal intensity was 62 +/- 4 dB after SA and 59 +/- 3 dB after PC. Vocal quality was measured by high-resolution vocal frequency analysis, as represented by a histogram. Peaks corresponding to fundamental frequency and first harmonics were preserved in more than 60% of patients in the two groups. Vocal preservation is better when the paralyzed folds are in the paramedian position, with the possibility of adduction (Gerhardt syndrome). SA is performed in our procedure, though it is longer and more difficult to perform than PC. PC often requires two procedures to achieve satisfactory results.
我们报告了内镜下二氧化碳激光治疗双侧内收性声带麻痹后的发声和呼吸结果。采用了两种技术：后联合切除术（PC）和次全杓状软骨切除术（SA）。通过呼气峰值流量/吸气峰值流量比值（PEF/PIF，正常=1）来证明呼吸改善，PC术后83%的患者以及SA术后81%的患者该比值小于2。至于发声结果，两种技术之间没有显著的定量差异。SA术后平均最大发声时间（/a/）为6.8±2.6秒，PC术后为7.8±1.6秒。SA术后发声商数为288±116毫升/秒，PC术后为304±92毫升/秒。SA术后平均发声强度为62±4分贝，PC术后为59±3分贝。通过高分辨率嗓音频率分析测量嗓音质量，以直方图表示。两组中超过60%的患者保留了对应基频和第一谐波的峰值。当麻痹的声带处于旁正中位置且有可能内收时（格哈特综合征），嗓音保留情况更好。在我们的手术中进行SA，尽管它比PC手术时间更长且更难操作。PC通常需要进行两次手术才能取得满意的效果。
