Mahieu H F, Norbart T, Snel F
Vrije Universiteit Amsterdam, Dept. Oto-rhino-laryngology Head & Neck Surgery, University Hospital Vrije Universiteit, The Netherlands.
Rev Laryngol Otol Rhinol (Bord). 1996;117(3):189-97.
Dysphonias resulting from incomplete glottis closure or inadequate vocal fold tension are eligible for phonosurgical correction. Many different phonosurgical techniques have been used for these indications, but the disadvantages associated with augmentation of the vocal folds by means of intracordal injections and the favourable reports concerning laryngeal framework surgery, have lead to a change in treatment policy in many centers. Most phonosurgeons presently advocate laryngeal framework surgery as the first treatment of choice. For correction of incomplete glottis closure usually thyroplasty type 1 and arytenoid adduction techniques are used. For correction of vocal fold tension cricothyroid approximation and thyroplasty type 3 can be used. Often combinations of different techniques are required to achieve the best result. It is therefore essential to perform these procedures under local anaesthesia, so that the voice can be monitored during the surgery and so that the surgery can be tailored to the patient's voice, 119 patients underwent laryngeal framework surgery, 85 of them for correction of incomplete glottis closure, which in 75 patients was due to unilateral vocal fold immobility. The results in this group were good also in long term follow-up. Complications were few and insignificant. For 30 patients, mostly transsexuals, the aim of surgery was to obtain a higher vocal pitch. This was successful in most patients, but 4 patients had cartilage fracture at the time of surgery as a result of the extreme cricothyroid approximation required. In all cases adequate repair could be obtained without further sequellae.
因声门关闭不全或声带张力不足导致的发音障碍适合进行嗓音外科矫正。针对这些适应症已经使用了许多不同的嗓音外科技术，但声带内注射增加声带的相关缺点以及有关喉框架手术的良好报告，导致许多中心的治疗策略发生了变化。目前大多数嗓音外科医生主张将喉框架手术作为首选治疗方法。对于声门关闭不全的矫正，通常使用1型甲状成形术和杓状软骨内收技术。对于声带张力的矫正，可以使用环甲肌靠拢术和3型甲状成形术。通常需要不同技术的组合才能取得最佳效果。因此，在局部麻醉下进行这些手术至关重要，这样在手术过程中可以监测声音，并且手术可以根据患者的声音进行调整。119例患者接受了喉框架手术，其中85例用于矫正声门关闭不全，75例是由于单侧声带麻痹所致。该组患者的长期随访结果也良好。并发症很少且不严重。对于30例患者，主要是变性者，手术目的是获得更高的音调。大多数患者取得了成功，但4例患者在手术时因需要极度环甲肌靠拢而发生软骨骨折。在所有病例中，均能获得充分修复且无进一步后遗症。
