喉頭垂直部分切除術後の発声機能に関する病態生理学的研究

抄録

The purpose of this paper is to clarify various factors in obtaining a good phonatory function following vertical partial laryngectomy.
Fifty patients with or without glottic reconstruction following vertical partial laryngectomy were investigated in the view point of phonatory function. Each case was examined with laryngogram and phonatory function tests which are maximum phonation time, mean air flow rate, phonation quotient, stroboscopy and listenability.
The following conclusions are obtained:
1) The defect after removal of the cancerous lesion following vertical partial laryngectomy should be filled with a muscle flap large enough to assure a complete glottic closure.
2) The muscle flap should be covered with oral or pharyngeal mucosa in order to obtain the smooth surface.
3) The top of the musclar bulge constructed on the affected side should be located at the level of the healthy vocal cord during phonation in order to prevent the false cord vibration.
4) The Hirano's technique for glottic reconstruction was estimated as the good method to satisfy those conditions described above.
5) The filled muscle flap became atrophic about 30 % in its size within the first month after surgery. The atrophy had been progressed approximately initial first year.
6) Since atrophy is expected, the musclar bulge should be made larger in size or the non-atrophic material should be applied.
7) A free graft of oral mucosa is more convenient than pedicle pharyngeal mucosa for the covering over the muscle flap, however, it should be considered that there is the risk that occasional necrosis will occur.