ABSTRACT
Objective: To evaluate the effectiveness of mucosal flap combined with silicone keel for preventing and treating anterior commissure adhesion in canines and clinical cases. Methods: A prospective experiment was performed from November 2019 to June 2021. Twenty five canines were randomly divided into 5 groups(A, B, C, D, E). Group A, B, C, D received anterior commissure injury by CO2 laser, then separately treated with free mucosal flap-keel complex,intralaryngeal mucosal flap-keel complex, silicone keels and without treatment, group E didn't injure the vocal cord after intubation. The keel was removed after 2 weeks, the larynx was harvested after 4 weeks. The effectiveness of anterior commissure adhesion prevention was evaluated by manifestation under laryngoscope, standard vocal cord length and standard glottic area. A retrospective analysis was performed on sixteen patients with anterior commissure lesion, who underwent mucosal flap-keel technique in Huashan Hospital of Fudan University from January 2019 to January 2021 (10 cases with free mucosal flap-keel complex and 6 cases with intralaryngeal mucosal flap-keel complex). All the patients underwent evaluation of laryngeal function included manifestation under laryngoscope each month and voice analysis before and 3 month after surgery. SPSS 20.0 software was used for statistical analysis. Results: No surgery accident or complication happened in canines and patients. The standard vocal cord length and standard glottic area after 4 weeks in group B were significantly higher than those in group A, C, D (Hstandard vocal cord length=31.688, Hstandard glottic area=16.444, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A were also significantly higher than those in group C, D(Hstandard vocal cord length=20.936, Hstandard glottic area=11.786, P<0.05). The standard vocal cord length and standard glottic area after 4 weeks in group A, B, E were not significantly different to that before surgery(tA left standard vocal cord length=2.636, tA right standard vocal cord length=2.582, tB left standard vocal cord length=2.707, tB right standard vocal cord length=2.673, tE left standard vocal cord length=0.370, tE right standard vocal cord length=0.821, tA standard glottic area=2.731, tB standard glottic area=2.753, tE standard glottic area=-0.529, P>0.05). The standard vocal cord length and standard glottic area after 4 weeks in group C, D were significantly lower than those before surgery(tC left standard vocal cord length=16.137, tC right standard vocal cord length=13.984, tD left standard vocal cord length=11.903, tD right standard vocal cord length=14.587, tC standard glottic area=10.280, tD standard glottic area=22.974, P<0.05). During 6-18 months of follow-up in clinical patients, no one developed a glottic web. Three months after surgery, Jitter, Shimmer, noise to harmonic ratio(NHR), the maximum phonation time(MPT)in all patients were significantly different from preoperative(tintralaryngeal mucosal flap jitter=24.885, tintralaryngeal mucosal flap shimmer=22.643, tintralaryngeal mucosal flap NHR=6.202, tintralaryngeal mucosal flap MPT=-9.661, tfree mucosal flap jitter=25.459, tfree mucosal flap shimmer=18.683, tfree mucosal flap NHR=5.705, tfree mucosal flap MPT=-20.840, P<0.05). Conclusion: Mucosal flap combined with silicone keel is an effective technique for preventing and treating anterior commissure adhesion. The effect of pedicled intralaryngea lmucosal flap is better.
Subject(s)
Animals , Dogs , Humans , Free Tissue Flaps , Glottis , Laryngeal Neoplasms/surgery , Prospective Studies , Retrospective Studies , Vocal Cords/surgeryABSTRACT
OBJECTIVES@#To identify diagnostic value of laryngeal electromyography (LEMG) in differentiating vocal fold paralysis (VFP) from arytenoid dislocation.@*METHODS@#The history, laryngeal morphologic characteristics and LEMG of 36 patients with VFP and 10 patients with arytenoid dislocation were compared and analyzed.@*RESULTS@#The most common cause of 36 VFP patients was surgical damage (24 cases), and the most common cause of 10 arytenoid dislocation patients was history of endotracheal intubation (9 cases). There was no statistical difference between the vocal fold and the fixed position of the vocal fold between the group of VFP patients and arytenoid dislocation patients. In the patients with VFP, 33 VFP patients (91.67%) had decreased recruitment; 9 cases (9/13) of denervation potential and 8 cases (8/9) of regeneration potential occurred within 1-6 months of the course of disease; 3 cases (3/4) of synkinesis occurred in the course of disease more than 6 months. In the patients with VFP, the amplitude (<0.01) and turns (<0.05) of thyroarytenoid muscles significantly decreased in the lesioned side comparing to the normal one, but the turns/amplitude ratio showed no statistical difference. In the patients with superior laryngeal nerve injury, the turns and amplitude analysis of cricothyroid muscles showed no statistical difference. All of 10 patients with arytenoid dislocation showed normal LEMG patterns.@*CONCLUSIONS@#LEMG can be used to differentiate the patients with vocal cord paralysis from arthrodesis dislocation, and can also carry out quantitative analysis to provide valuable help for the diagnosis.