Sataloff R T, Spiegel J R, Hawkshaw M, Rosen D C, Heuer R J
Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
J Voice. 1997 Jun;11(2):238-46.
New insights into the anatomy and physiology of phonation, along with technological advances in voice assessment and quantification, have led to dramatic improvements in medical voice care. Techniques to prevent vocal fold scar have been among the most important, especially scarring and hoarseness associated with voice surgery. Nevertheless, dysphonia due to vocal fold scar is still encountered all too frequently. Although it is not generally possible to restore such injured voices to normal, patients with scar-induced dysphonia can usually be helped. Voice improvement is optimized through a team approach. Treatment may include sophisticated voice therapy and vocal fold surgery. Although experience with collagen injection has been encouraging in selected cases (particularly in those involving limited areas of vocal fold scar), there is no consistently successful surgical technique. Attempts to treat massive vocal fold scar, such as may be seen following vocal fold stripping, have been particularly unsuccessful. This paper reports preliminary experience with the implantation of autologous fat into the vibratory margin of the vocal fold of patients with severe, extensive scarring. Using this technique, it appears possible to recreate a mucosal wave and improve voice quality. Additional research is needed.
对发声解剖学和生理学的新见解，以及嗓音评估和量化技术的进步，已使医学嗓音护理取得了显著改善。预防声带瘢痕的技术一直是最重要的技术之一，尤其是与嗓音手术相关的瘢痕形成和声音嘶哑。然而，声带瘢痕导致的发音障碍仍然屡见不鲜。虽然一般不可能将此类受损嗓音恢复正常，但瘢痕性发音障碍患者通常能得到帮助。通过团队协作的方法可使嗓音改善达到最佳效果。治疗可能包括复杂的嗓音治疗和声带手术。尽管在某些特定病例（特别是那些涉及声带瘢痕有限区域的病例）中，胶原蛋白注射的经验令人鼓舞，但尚无始终成功的手术技术。治疗大面积声带瘢痕（如声带剥脱术后所见）的尝试尤其不成功。本文报告了将自体脂肪植入重度广泛瘢痕形成患者声带振动边缘的初步经验。使用该技术，似乎有可能重现黏膜波并改善嗓音质量。还需要进一步研究。
