What is Laryngoplasty?
Ronda Alexander, MD
助理教授
经常在医学,我们治疗疾病或者能力tpaces our reconstructive capacity. This was long the case in Otolaryngology which for years provided curative surgery but had little to offer patients who suffered cosmetic and functional defects after. The past century, however, served as a period of ‘catch-up’ and the larynx also finally garnered the attention it deserved. We now have options to improve the quality of life of patients whose illnesses or treatments have left them with vocal cord paralysis (VCP). VCP can result from myriad causes including viral illnesses, brain diseases, and surgical or traumatic injuries to the laryngeal nerves. For these patients, the inability to fully close the glottis can result in breathy, unpredictable voices as well as dysphagia and decreased cough strength. In order to achieve optimal function, patients require a team approach that gives them both the anatomic and technical tools to generate good voice.
理想的外科手术治疗将在内侧移动声带边缘，以便在不干扰任何一个语音振动的情况下相遇。1974年，日本京都的Nobuhiko Isshiki博士描述了几种类型的喉成形术，其中包括完成声带的内侧化和改善的发光闭合。数十年来，该技术已被完善，并成为手术语音康复的重要工具。
Medialization laryngoplasty involves exposing the larynx through an incision in the neck and creating a ‘window’ in the cartilage through which an implant can be placed while the larynx is observed with a flexible scope. Many different materials are used as implants including carved silastic or ceramic blocks, Gore-tex® strips, and silastic shims. The procedure is usually performed using a special anesthesia technique as there are periods when the patient must be comfortable enough to tolerate the operation but during the placement of the implant, s/he must be alert enough to respond to commands and speak so that the size can be customized. Patients are usually observed overnight in the hospital and discharged the following morning if there are no complications. Surgical risks include infection, bleeding and the possibility of an implant moving or extruding into the airway. They can also be made too small, too large and placed incorrectly. When done well, patients will experience an improvement in objective measures like loudness, maximum phonation time and noise-to-harmonic ratio as well as subjective improvements in breathiness, effort of phonation and vocal predictability. These changes are considered permanent and generally do not decline over time.
In addition to this surgical structural change, there are also injectable implants available. This option uses materials as diverse as fat, human dermis, cultured hyaluronic acid (a component of human joint fluid), and an engineered bone analogue. The advantage of this technique is that, with the right patient and material, it can be performed under local anesthesia with the patient awake in the office. This reduces both the cost and time spent on the procedure. For those who are too nervous for this, it can also be done under general anesthesia and remains quick and effective. There is mounting evidence that injections of fat and bone dust can last for many years and that the durability of the results is comparable with those from laryngoplasty. These injections do, however, require a skilled hand as they carry risks of bleeding and possibly permanent voice damage if one material is injected improperly.
当然，没有适当的康复，这两种治疗方法都不完整。患者需要在安全使用新声音方面进行培训。他们在手术矫正之前使用的补偿性演习不需要学习，这可能是艰苦的，需要训练有素的专业人士。此外，在最初的术后时期，声音中通常会有明显的抖动和微光。当患者发现新声音时，必须通过康复进行指导。经过几次声乐康复疗法，他们返回外科医生进行另一次检查并审查其进度。言语病理学家和喉科医生之间的良好沟通是至关重要的，而不执行频镜检查的SLP应在可能的情况下查看外科医生记录的那些。有了合适的团队，单方面声音折叠的患者在面对其他医疗挑战时可以恢复声音的良好选择。让我们一起工作以帮助他们再次听到！