目的:已经报道了几种用于治疗单侧声带麻痹(UVFP)的手术技术。尽管开窗方法最近在某些情况下已应用于arytenoid内收(AA),缺乏对其有用性的长期大队列研究。因此,本研究旨在评估该技术在UVFP患者中的长期嗓音结局.
方法:回顾性研究。
方法:共有168例UVFP患者接受了喉成形术,包括通过甲状腺ala开窗术联合I型甲状腺成形术(TPI)进行的AA。测量手术前后的最大发声时间(MPT)和平均气流速率(MFR),语音分析包括对闪烁和抖动的估计。在下甲状腺ala中创建前后手术窗,并用于典型的TPI和AA,分别。基于三维计算机断层扫描数据确定窗口位置。AA是通过将软骨软骨的肌肉过程通过后窗拉向环软骨外侧肌肉而不释放环甲关节来进行的。所有手术均在局部麻醉下进行,并通过内窥镜检查证实了中介化。
结果:168例患者中有156例患者术后MPT>10秒。术后,除两名患者外,所有患者的MFR均改善至<250mL/s,MPT,MFR,抖动,所有患者的微光明显改善。此外,使用年级的感性评价,粗糙度,呼吸,Asthenia,应变量表显示所有患者均有明显改善。
结论:开窗入路保留了环甲关节,不会打开环甲关节;因此,喉软骨稳定了,并且没有发生喉部框架的变形。我们的结果表明,通过开窗方法联合AA和TPI可在UVFP患者中提供稳定的长期术后语音改善。
方法:第3级。
OBJECTIVE: Several surgical techniques have been reported for the treatment of unilateral vocal fold paralysis (UVFP). Although the fenestration approach has recently been applied for arytenoid adduction (AA) in some cases, long-term large-cohort studies on its usefulness are lacking. Therefore, this study aimed to evaluate the long-term voice outcomes of this technique in patients with UVFP.
METHODS: Retrospective study.
METHODS: A total of 168 patients with UVFP underwent
laryngoplasty comprising AA performed through fenestration of the thyroid ala combined with a type I thyroplasty (TPI). The maximum phonation time (MPT) and mean airflow rate (MFR) were measured before and after surgery, and voice analysis included an estimation of shimmer and jitter. Anterior and posterior surgical windows were created in the lower thyroid ala and were used for typical TPI and AA, respectively. The window locations were determined based on three-dimensional computed tomography data. AA was performed by pulling the muscular process of the arytenoid cartilage toward the lateral cricoarytenoid muscle through the posterior window without releasing the cricothyroid joint. All surgeries were performed under local anesthesia, and medialization was endoscopically confirmed.
RESULTS: Postoperative MPT >10 seconds was achieved in 156 of the 168 patients. Postoperatively, MFR improved to <250 mL/s in all but two patients, and MPT, MFR, jitter, and shimmer significantly improved in all patients. Furthermore, perceptual evaluation using the Grade, Roughness, Breathiness, Asthenia, and Strain scale revealed significant improvement in all patients.
CONCLUSIONS: The fenestration approach preserves the cricothyroid joint and does not open the cricoarytenoid joint; therefore, the laryngeal cartilage is stabilized, and no distortion of the laryngeal framework occurs. Our results showed that combined AA and TPI via the fenestration approach provided stable long-term postoperative voice improvement in patients with UVFP.
METHODS: Level 3.