vocal cord transposition

In the past 20 years, with the improvement of the physiological and pathological knowledge of the vocal function of the larynx, as well as the development of diagnosis and treatment techniques for vocal diseases, such as dynamic laryngoscopy, laryngeal microsurgery, laser surgery, etc., the laryngeal surgery has been achieved. It can not only remove the lesion, but also preserve or improve the function of the voice. Therefore, the vocal surgery developed on the basis of laryngology to improve the voice has been widely promoted worldwide. Von Leden et al. (1989) pointed out that snoring surgery is the "aesthetic surgery of the voice system for improving the voice". It is the surgical function to restore or reconstruct the vocal function of the throat, so that the voice is clear, loud and pleasing. , has rhythm, and meets the purpose of its age and gender characteristics. The main surgical techniques included in the voice surgery include: 1 vocal cord benign lesion removal; 2 unilateral vocal cord paralysis midline internal thrust, tonal abnormal surgery; 3 recurrent laryngeal nerve paralysis nerve graft or neuromuscular pedicle graft; 4 larynx Tumor resection and partial reconstruction. Treating diseases: vocal cord polyps Indication 1, unilateral vocal cord paralysis, the vocal cord on the affected side is fixed in the middle or outreach position, and the patient is ineffective after 6 months of vocal training. 2. The glottic gate is incomplete after laryngeal trauma or laryngeal surgery. Surgical procedure 1. Intra-vocal injection is used to correct the poor vocal cord closure and the relatively small distance between the vocal cords on both sides. There are four main types of materials for intra-vocal injection: Teflon, silica gel, fat, and collagen. When selecting Teflon or silica gel, the injection material should be injected between the nail muscle or (and) thyroid cartilage and the nail muscle. Do not inject or approach the material to the vocal cord mucosa, as the injection of Teflon or silica gel may cause vocal cord mucosa. Hardening, causing significant vocal cord mucosal vibration and even loss of sound. The density of collagen is close to normal mucosal tissue and can be injected near normal mucosal tissue. At present, fat is often used as an injection material, and the advantage is that the source is convenient, and the fat tissue is compatible, and the texture is close to the vocal cord tissue; the drawback is that it is easily absorbed and affects the long-term effect. The injection technique is to inject the injection material into the vocal cord muscle layer through a special injection needle under a general anesthesia support laryngoscope, and to improve the closing of the glottis by increasing the volume of the vocal cord. 2, vocal cord internal transfer surgery is used to correct the poor vocal cord closure, the distance between the vocal cords on both sides is large, especially the gap between the posterior part of the glottis (the vocal cord cartilage) is large, and it is estimated that the injection effect in the vocal cord is not good. The surgical method is to fill the vocal cord plane of the thyroid cartilage by opening the window on the thyroid cartilage plate, and the vocal cord is moved inward toward the midline. Commonly used filling materials are silicone blocks, Teflon compression bands and autologous cartilage. Autologous cartilage can be taken from thyroid cartilage, nasal septal cartilage, costal cartilage. A transverse incision of about 3 cm was made at the middle and lower 1/3 junction of the thyroid cartilage plate on the lesion side. The anterior soft tissue was separated to expose the thyroid cartilage plate, and a rectangular cartilage block was cut. The length was 8 to 10 mm and the width was 3 to 5 mm. The vertical side of the front of the rectangle is parallel to the midline of the thyroid cartilage, so that the midpoint of the vertical side is at the same level as the starting point of the front end of the vocal cord, and is 5 to 7 mm away from the center line. When cutting the rectangular cartilage plate, be careful not to damage the cartilage endometrium, bluntly separate the endarterum of the cartilage, fill in the prepared filling material, observe the extent of the vocal cords moving inward under the laryngoscope, and make the position of the vocal cords on the paralyzed side slightly. More than the middle line. The layers of soft tissue and skin are then sutured in sequence.

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