A new classification of maxillary defect and simultaneous accurate reconstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To select the preferred flaps for the reconstruction of different maxillary defects and to propose a new classification of maxillary defects. Methods: A total of 219 patients (136 males and 83 females) underwent the simultaneous reconstruction of maxillary defects in the Beijing Tongren Hospital, Capital Medical University, between January 2005 and December 2018 were reviewed. Age ranged from 16 to 78 years. Based on the proposed new classification of the maxillary defects, 22 patients with class Ⅰ defects (inferior maxillectomy), 44 patients with class Ⅱ defects (supperior maxillectomy), 132 patients with class Ⅲ defects (total maxillectomy) and 21 patients with class Ⅳ defects (extensive maxillectomy) were enrolled. Survival rate, functional and aesthetic outcomes of flaps were evaluated. Survival analysis was performed in 169 patients with malignant tumor, Kaplan-Meier method was used to calculate the survival rate, and Log-rank method was used to compare the difference of survival rate in each group. Results: A total of 234 repairs for maxillary defects were performed in 219 patients. Fibula flaps were used in 4/13 of class Ⅰ defects; temporal muscle flaps (11/24, 45.8%) and anterolateral thigh flaps (6/24, 25.0%) used in class Ⅱ defects; temporal muscle flaps (71/128, 55.5%), anterolateral thigh flaps (6/24, 25.0%) and fibula flaps (12/128, 9.4%) used in class Ⅲ defects; and anterolateral thigh flaps (8/20, 40.0%) and rectus abdominis flaps (8/20, 40.0%) used in class Ⅳ defects. The success rate of local pedicled flaps was 95.6% (109/114) and that of free flaps was 95.8% (115/120). Thrombosis(10/234,4.3%) was a main reason for repair failure. Among the followed-up 88 patients, swallowing and speech functions recovered, 82 (93.2%) of them were satisfied with appearance, and 75 (85.2%) were satisfied with visual field. The 3-year and 5-year overall survival rates were 66.5% and 63.6%, and the 3-year and 5-year disease-free survival rates were 57.1% and 46.2%, respectively, in the 169 patients with malignant tumors. Conclusion: A new classification of maxillary defects is proposed, on which suitable flaps are selected to offer patients good functional and aesthetic outcomes and high quality of life.

Clinical comparative study of free posterior tibial artery perforator flap and radial forearm free flap for head and neck reconstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the clinical application results of the FPTF (free posterior tibial artery perforator flap) and RFFF (radial forearm free flap) for reconstruction of head and neck defects. Methods: A retrospective analysis of 27 cases treated with FPTF (19 males and 8 females, aged 14-69 years) and 24 cases with RFFF (11 males and 13 females, aged 22-69 years) for head and neck defect reconstruction at Beijing Tongren Hospital of Capital Medical University from January 2015 to December 2020 was conducted. Flap size, vascular pedicle length, matching degree of recipient area blood vessels, preparation time, total operation time, hospital stay, recipient area complications, donor area complications and scale-based patient satisfaction were compared between two groups of patients with FTPF and RFFF. SPSS 26.0 statistical software was used for statistical analysis. Results: There was no statistically significant difference between the two groups of patients in tumor T staging (P=0.38), primary sites (P=0.05) and mean flap areas ((53.67±29.84) cm2 vs. (41.13±11.08) cm2, t=-1.472, P=0.14). However the mean vascular pedicle length of FPTF was more than that of RFFF ((11.15±2.48)cm vs. (8.50±1.69)cm, t=-4.071, P<0.01). The donor sites of 4 patients in FPTF group could be sutured directly, while all the 24 patients in RFFF group received skin grafts from the donor sites. There was no statistically significant difference in the recipient area arteries between two groups of flaps (P=0.10), with more commonly using of the facial artery (RFFF: FPTF=21∶27), but there was significant difference in the recipient area veins (P<0.01), with more commonly using of the external jugular vein in RFFF (14/24) than FPTF (4/32) and the posterior facial vein in FPTF (27/32) than RFFF (9/24). There were 10 recipient complications and 3 donor complications in RFFF group; no recipient complication and 3 donor complications occurred in FPTF group. With patient's subjective evaluation of the donor site at 12 months after surgery, FPTF was better than RFFF (χ²=22.241, P<0.01). Conclusions: FPTF is an alternative to RFFF in head and neck reconstruction and has unique advantages in aesthetics and clinical application.

Retrospective study of thyroid invasion and central lymph node metastasis in 124 patients with hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the characteristics of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma, and the impact on survival rate and quality of life. Methods: A retrospective analysis of 124 cases (122 males and 2 females with age range from 36 to 78 years old) with laryngopharyngeal squamous cell carcinoma who were initially treated in the Department of Head and Neck Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2014 to December 2017 was performed. The clinical data included tumor location, pathological T stage, pathological N stage, invasion of thyroid gland, central lymph node metastasis, surgical procedures and so on. Patients were grouped according to if presence of thyroid invasion and central lymph node metastasis. With follow-up, the survival was analyzed by Kaplan-Meier method, and tumor recurrence and metastasis were evaluated. Results: Of the patients, 12 patients had thyroid involvement and 5 patients had central lymph node metastasis. The incidence of thyroid involvement was 8.16% (8/98) in pyriform sinus, 1/18 in posterior pharyngeal wall and 3/8 in posterior cricoid wall, with statistically significant difference (χ2=15.076,P=0.008). The incidence of central lymph node metastasis was 1.02% (1/98) in pyriform sinus, 3/18 in posterior pharyngeal wall and 1/8 in posterior cricoid wall, also with statistically significant difference (χ2=11.205, P=0.008). There was no statistical correlation between thyroid invasion or central lymph node metastasis and gender, smoking or alcohol exposure history and tumor pathological differentiation (all P>0.05). The 3-year overall survival rate was 80.65% and the 3-year recurrence free rate was 85.48%. Totally 24 patients died in 3 years, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. Local recurrence occurred in 18 patients, including 4 cases in thyroid invasion group and 1 case in central lymph node metastasis group. There was no significant difference in survival between patients with and without thyroid invasion and central lymph node metastasis (all P>0.05). There were significantly difference in 3-year overall survival and relapse-free survival among the groups with different T stages, N stages, pathological stages and tumor pathological differentiation levels (all P<0.05). There were significantly differences in the levels of serum calcium and FT3 between the groups with or without thyroid invasion and central lymph node metastasis (all P<0.05). Conclusion: The incidences of thyroid invasion and central lymph node metastasis of hypopharyngeal carcinoma are rare, and the risk of occurrence is related to the primary site of tumor. Comprehensive evaluation, correct decision-making and accurate treatment could be helpful to cure radically the tumor, to prevent recurrence and to improve the quality of life of patients.

Silencing novel long non-coding RNA FKBP9P1 represses malignant progression and inhibits PI3K/AKT signaling of head and neck squamous cell carcinoma in vitro / 中华医学杂志(英文版)

BACKGROUND@#Long non-coding RNAs (lncRNAs) play key roles in human cancers. In our previous study, we demonstrated that lncRNA FKBP prolyl isomerase 9 pseudogene 1 (FKBP9P1) was highly expressed in head and neck squamous cell cancer (HNSCC) tissues. However, its functional significance remains poorly understood. In the present study, we identify the role and potential molecular biologic mechanisms of FKBP9P1 in HNSCC.@*METHODS@#Quantitative real-time polymerase chain reaction was used to detect the expression of FKBP9P1 in HNSCC tissues, matched adjacent normal tissues, human HNSCC cells (FaDu, Cal-27, SCC4, and SCC9), and human immortalized keratinocytes cell HaCaT (normal control). Cal-27 and SCC9 cells were transfected with sh-FKBP9P1-1, sh-FKBP9P1-2, and normal control (sh-NC) lentivirus. Cell counting kit-8 assay, colony formation assay, wound healing assay, and trans-well assay were used to explore the biologic function of FKBP9P1 in HNSCC cells. Furthermore, western blotting was used to determine the mechanism of FKBP9P1 in HNSCC progression. Chi-squared test was performed to assess the clinical significance among FKBP9P1 high-expression and low-expression groups. Survival analyses were performed using the Kaplan-Meier method and assessed using the log-rank test. The comparison between two groups was analyzed by Student t test, and comparisons among multiple samples were performed by one-way analysis of variance and a Bonferroni post hoc test.@*RESULTS@#FKBP9P1 expression was significantly up-regulated in HNSCC tissues (tumor vs. normal, 1.914 vs. 0.957, t = 7.746, P < 0.001) and cell lines (P < 0.01 in all HNSCC cell lines). Besides, the median FKBP9P1 expression of HNSCC tissues (1.677) was considered as the threshold. High FKBP9P1 level was correlated with advanced T stage (P = 0.022), advanced N stage (P = 0.036), advanced clinical stage (P = 0.018), and poor prognosis of HNSCC patients (overall survival, P = 0.002 and disease-free survival, P < 0.001). Knockdown of FKBP9P1 led to marked repression in proliferation, migration, and invasion of HNSCC cells in vitro (P all < 0.01). Mechanistically, silencing FKBP9P1 was observed to restrain the PI3K/AKT signaling pathway.@*CONCLUSIONS@#Silencing lncRNA FKBP9P1 represses HNSCC progression and inhibits PI3K/AKT (phosphatidylinositol 3 kinase/AKT Serine/Threonine Kinase) signaling in vitro. Therefore, FKBP9P1 could be a potential new target for the diagnosis and treatment of HNSCC patients.

Analysis for potential targeting genes of TPF regimen induction chemotherapy in hypopharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

To analyze the differentially expressed genes related to the chemosensitivity with the TPF regimen for hypopharyngeal squamous cell carcinoma and to measure potential functional targeting genes expressions. Twenty-nine patients with primary hypopharyngeal cancer who underwent induction chemotherapy with TPF from January 2013 to December 2017 in Beijing Tongren Hospital were enrolled for microarray analysis, including 28 males and 1 female, aged from 43 to 73 years old. Among them, 16 patients were sensitive to chemotherapy while 13 patients were non-sensitive. Illumina Human HT-12 Bead Chip was applied to analyze the gene expressions and online bioinformatics analysis was used to analyze the differentially expressed genes. Reverse transcription and quantitative real-time PCR (RT-qPCR) was used to measure the mRNA expression of potential functional genes of TPF induction chemotherapy in 43 samples, 29 from original patients and 14 from additional patients. Graphpad prism 7.0 software was used for statistical analysis. A total of 1 381 significantly differentially expressed genes were screened out. By GO analysis, up-regulated genes included sequestering in extracellular matrix, chemokine receptor binding and potassium channel regulator activity; down-regulated genes included regulation of angiogenesis, calcium ion binding and natural killer cell activation involved in immune response. With KEGG database analysis, down-regulated pathways included ECM-receptor interaction and peroxisome and up-regulated pathways included Glutathione metabolism and PPAR signaling pathway. The expressions of CD44 and IL-6R were significantly different and appeared biologically significant. CD44 was significantly upregulated in insensitive tissues (0.54±0.06) compared with sensitive tissues (0.33±0.04)(0.01). IL-6R was significantly downregulated in insensitive tissues (0.44±0.03) compared with sensitive tissues. (0.68±0.03) (0.01). CD44 and IL-6R may be potentially functional genes of TPF induction chemotherapy in hypopharyngeal squamous cell carcinoma.

Study on the stability of perceptual evaluation of voice quality / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the factors that influence the stability of evaluation results judged by a jury through a standard research on perceptual evaluation measurements of voice quality.</p><p><b>METHODS</b>Voice samples from 300 patients with dysphonia and 100 control subjects with normal voice were recorded and assessed by a jury composed of 6 experienced listeners from different hospitals. The voice samples were discourse voices and ordered randomly 3 times, and the mean of 3 evaluations using visual analogue scale were the final results. The jury was instructed to classify voice samples according to the G (grade), R (rough) and B (breathy) components of the GRBAS scale on a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. Κ value was used to analyze the concordance of evaluation results and regression analysis was used to research the effects of the extent of voice disorder to the stability of perceptual evaluation.</p><p><b>RESULTS</b>The discordance of evaluation existed both between the jury and in listeners themselves. The concordance of listeners themselves of each evaluation parameter was not bad, good, or even very good, and the concordance of evaluation of G was the best (κ value: 0.46 - 0.85), then R (κ value: 0.41 - 0.84) and B (κ value: 0.41 - 0.81). The concordance between the jury was worse than that in themselves. And except a listener whose concordance of evaluation was under the requirement, the concordance of evaluation of G was the best (κ value: 0.43 - 0.96), then R (κ value: 0.33 - 0.78) and B (κ value: 0.002 - 0.45). The stability of evaluation of normal voice and severe voice disorder was better than mild and moderate voice disorder.</p><p><b>CONCLUSIONS</b>The discordance between the jury was the main factor that influence the stability of perceptual evaluation. The evaluation parameters and extent of voice disorder will influence the stability of perceptual evaluation of the jury.</p>

Self-assessment characteristics of voice handicap index for voice disorders and its influencing factors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the self-assessment characteristics of Voice Handicap Index (VHI) for voice disorders and its influencing factors.</p><p><b>METHODS</b>One thousand seven hundred and sixty six dysphonic patients and 120 control subjects were included in this study. Two hundred twenty seven patients were treated with phonosurgery or Botulinumtoxin injection. VHI was used for self-assessment.</p><p><b>RESULTS</b>Dysphonic patients had worse VHI scores than control (z from 8.039 to 17.043, P = 0.000). There was a significant difference among the VHI scores of different diseases. VHI scores were descending in order among spasmodic dysphonia, vocal fold paralysis, functional dysphonia, sulcus vocalis, benign and malignant tumor of vocal fold, vocal fold cyst, Reinke's edema, vocal fold polyp, vocal fold keratosis and chronic laryngitis, vocal nodule. The emotional scores were the highest in spasmodic dysphonia, and followed by functional dysphonia. In another group, the physical scores were higher than functional scores and emotional scores. Treatment resulted in statistical improvement in VHI scores (P < 0.05). The total scores were different significantly between different educational background and age groups (F from 8.701 to 27.371, P = 0.000). The higher the educational degree, the higher the VHI scores. As to age groups, the juvenile group's scores were the lowest, while the youth's group the highest, then the scores declined when ages increased.</p><p><b>CONCLUSION</b>As a useful supplementary instrument to measure the voice disorder severity and the treatment's effect, VHI can comprehensively assess the voice handicap's affect to the life quality and the difference after the treatment, especially in physical, functional and emotional aspects, but it is somehow subject to the educational degree and age.</p>

Analysis of reliability and validity of the Chinese version of voice handicap index (VHI) / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the reliability and validity of the Chinese version of voice handicap index (VHI).</p><p><b>METHODS</b>The cross-cultural adaptation of health-related quality of life (HRQOL) measures was used to evaluate the Chinese version of VHI. Five hundred forty six dysphonic patients and 80 control subjects were included, 30 of patients and 20 of control subjects also had Hong Kong version VHI test simultaneously.</p><p><b>RESULTS</b>The internal consistency reliability of overall VHI scores and three subscale scores of the Chinese version of VHI were 0.8657-0.9517. The reliability coefficients (test to retest, 2-week interval) was 0.992 (P < 0.001). The correlation coefficient of overall VHI scores and three subscale scores and internal subscale scores were 0.643-0.904 (P < 0.01). There were no significant difference between the Chinese version and Hong Kong Chinese version (Z = 0.397, P = 0.691 ) with high dependability (r = 0.995, P < 0.001). The factor analysis of construct validity shows that the eigenvalue of 6 factors is above 1. The cumulative proportion was 77.24%. The loading was higher than 0.4 among every item. VHI total scores were significantly higher in dysphonic patients than in control subjects (Z = 17.69, P = 0.000). This is also true for all VHI subscores in the functional (Z = 14.14, P = 0.000), physical (Z = 17.68, P = 0.000) and emotional domains (Z = 15.50, P = 0.000).</p><p><b>CONCLUSIONS</b>The Chinese version of VHI had a good reliability and validity. It can be used to evaluate dysphonic patients.</p>

Laryngopharyngeal characteristics of myasthenia gravis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To observe the laryngopharynx manifestation and electromyography characteristics of myasthenia gravis (MG) patients.</p><p><b>METHODS</b>Thirty cases of MG were included in this study, their laryngopharynx symptoms and signs, voice acoustic assessment, laryngeal electromyography (LEMG) behaviors and repetitive nerve stimulation test(RNS) were analyzed, and the data was compared with that of normal subjects.</p><p><b>RESULTS</b>About 36.7% of MG patients (11/30) had the symptoms of hoarseness, voice fatigue, dysphonia and dysphagia. The vocal folds movements of 16.7% of MG patients(5/30) appeared weaker than normal, and their vocal glottic couldn't close completely, while with a seam during phonation. Voice amplitude (68.3 +/- 14.6) dB (x +/- s, same at below), and maximum phonation time (15.1 +/- 4.0) s, were greatly lower than normal; shimmer(2. 43 +/- 1.19)%, and normalized noise energy (-9.6 +/- 3.3) dB, were greatly higher than normal. The amplitudes of interference patterns in MG patients' LEMG markedly decreased, except introarytenoid muscle, during low, normal and high pitch phonation, the amplitudes of thyoiarytenoid muscle were (215 +/- 69) microV, (298 +/- 113) microV and (380 +/- 153) microV, those of cricoarytenoid muscle were (253 +/- 92) microV, (361 +/- 116) microV and (486 +/- 155) RV. The turns increased but had no statistical difference. In the RNS test, 83.3% MG patients (25/30) showed masculine response. There were about 2.20 +/- 1.32 pieces of laryngeal muscles involved, and the reduction rate in amplitude of the compound muscle action potential for RNS was about (27.9 +/- 19.2)%.</p><p><b>CONCLUSIONS</b>Only parts of MG patients had laryngopharyngeal symptoms, but the laryngeal muscles of most of them were involved, appearing as the masculine response for RNS, the decreased synchronization of the laryngeal muscles' interference patterns, the decreased capacity of phonation. MG must be differentiated when a patient has the symptoms of voice weakness, hoarseness and dysphonia. Laryngeal RNS test should be used in the early diagnosis of MG.</p>

Characteristics of normal laryngeal nerve evoked potentials / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the behaviors of normal recurrent laryngeal nerve and superior laryngeal nerve evoked electromyography, to know the reference values of related parameters.</p><p><b>METHODS</b>Thirty six normal subjects were studied with laryngeal evoked electromyography. The latent period, duration, and amplitude of the evoked potentials (EP) recorded in laryngeal muscles were investigated.</p><p><b>RESULTS</b>The latent period of the EP recording from the thyroarytenoid muscles (TA), after stimulating recurrent laryngeal nerve (RLN), was (1.13 - 2.25) ms (x +/- 2s), that of TA after stimulating vagus nerve (VN) was (2.57 - 5.85) ms. There were significant differences in the latent periods of EP between RLN and VN (P < 0.01), and the latent periods of EP recording from TA after stimulating right cervical part of VN, (2.01 - 4. 53) ms (x +/- 2s) were significant shorter than those of left, (3.70 - 6.98) ms (x +/- 2s, P < 0.01). The durations of the EP were somewhat different but not significant. The amplitudes of the EP in different laryngeal muscles changes markedly. The wave form and latent period of the EP recording from cricothyroid muscle (CT), after stimulating the external branch of superior laryngeal nerve (SLN), was similar with the EP of RLN, the reflective EP R1 and R2 could be recorded from TA, posterior cricoarytenoid muscles (PCA), CT after stimulating the internal branch of SLN.</p><p><b>CONCLUSIONS</b>The characteristics of the EP recorded in laryngeal muscles after stimulation of RLN, SLN and VN are different. The latent period, duration and amplitude are important parameters in the evaluation of laryngeal nerves function, the latent period is the most important parameter.</p>

Use of endoscopic placement of laryngeal stent combined with mucosal suturing of vocal fold for the treatment of laryngeal web / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of laryngeal stent combined with vocal fold mucosal suture for treating laryngeal web.</p><p><b>METHODS</b>A retrospective study performed, 21 laryngeal web cases were included in this study. The web causes were previous vocal fold surgery for benign lesions in 8 cases, previous laryngeal surgery for recurrent papilloma in 6 cases, laryngeal trauma in 6 cases, and congenital web in 1 case. Fifteen adults received glottic silastic sheet keels placement with vocal fold suture, another 2 adults and 4 children only had vocal fold suture, the above procedures were performed with laryngeal endoscopy.</p><p><b>RESULTS</b>Among all patients, good glottis shape was achieved and good voice maintained, 6 months to 3 years follow-up showed open airway without restenosis. 15 adults who had both keels placement and vocal cord suture tolerated the keel well. Keel removal under direct laryngoscopy was performed 3-4 weeks after surgery. A normal triangular shaped glottis anterior commissure anatomy was restored in 14 patients and 2-3 mm residual webbing was found in 1 patient (who had laryngofissure history). 2-3 mm residual webbing was found in 4 children who only had endoscopic vocal fold suture. After receiving endoscopic vocal fold suture, 2 adults who was found to have 2-3 mm normal mucosal membrane in anterior commissure during surgery, restored normal vocal cord shape.</p><p><b>CONCLUSIONS</b>The study shows that silastic keel placement combined with vocal fold mucosal suture was successful for treating laryngeal webs cases. Mucosal suturing of vocal fold may decrease or eliminate raw surface exposure and it is useful in the management of pediatric laryngeal webs and webs with normal mucosal membrane in anterior commissure. The potential benefits of those procedures are in avoiding long-term glottic stenting, laryngofissure, and tracheotomy.</p>

Laryngeal electromyographic characteristics of vocal fold immobility / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of laryngeal electromyography and evoked electromyography in vocal fold immobility.</p><p><b>METHODS</b>108 cases of vocal fold immobility were analyzed by clinical manifestation and laryngeal electromyography characteristics, including spontaneous potential activity, motor unit potential (MUP) measurement, recruitment pattern analysis and evoked electromyography evaluation.</p><p><b>RESULTS</b>Neurogenic vocal fold immobility showed a wide variety of abnormal activity. Fibrillation potentials and positive sharp waves were found in patients with laryngeal nerve injuries. For laryngeal paralysis, there was no reaction with LEMG and evoked LEMG. For laryngeal paresis, it showed decreased MUP and decreased recruitment activities with simple pattern recruitment or mixed pattern recruitment, and decreased evoked muscle response potentials were also shown with delayed latency than normal (P < 0.05) in the TA (2.2 +/- 1.0) ms(x +/- s), PCA (2.4 +/- 1.0) ms and lower amplitude in the TA (0.9 +/- 0.7) mV and PCA (1.2 +/- 1.0) mV (P < 0.05). Patients with vocal fold mechanical limitations generally yielded normal LEMG and Evoked LEMG. Patients with neoplastic infiltration of the laryngeal muscles demonstrated decreased LEMG and nearly normal Evoked LEMG with normal latency and lower amplitude.</p><p><b>CONCLUSIONS</b>General EMG and evoked EMG play a crucial role in the diagnosis of vocal fold immobility.</p>

Patterns of spasmodic dysphonia and botulinum toxin injections / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the patterns of spasmodic dysphonia and the outcome treated with botulinum toxin A injections.</p><p><b>METHODS</b>All subjects were studied with acoustic analysis, laryngostroboscopy and laryngeal electromyography (EMG) including motor unit potential measure (MUP), recruitment pattern analysis and evoked electromyography. All the patients with spasmodic dysphonia were received botulinum toxin A (BOTOX) injections in each affected muscles and mostly under electromyographic guidance.</p><p><b>RESULTS</b>Among 22 cases of spasmodic dysphonia, 18 cases of adductor dysphonic patients have strained, strangled voice with intermittent breaks in speech as a consequence of hyperadduction and spasm of the vocal folds during phonation. Two patients had synchronous pharyngeal, lingual and velar tremor. Amplitudes of MUP of thyroarytenoid muscle (TA) were greater in patients group than in normal group (P < 0.01); The recruitment activity was increased and the amplitudes were greater than normal group (700-2500 microV) and the duration of activity of the TA during phonation was also notably greater in patients group than in normal group. Four cases of abductor dysphonic patients have a breathy, effortful hypophonic voice with abrupt termination of voicing. Amplitudes of MUP of posterior cricoarytenoid muscle (PCA) in patients group were increased up to 374 to 538 microV. The recruitment activity was increased and the amplitude was greater than normal(3000-5000 microV). In the adductor dysphonic group, patients who were treated with unilateral toxin injection had good results with 2.5 U or more. The average onset of toxin effect in all adductor dysphonic patients was at 6 hours to 2 days (1.4+/-0. 8) days (x +/- s), with a peak effect at 2 weeks and the follow-up EMG showed fibrillation potentials or electric silence in injected muscle. Duration of benefit was 8 to 24 weeks (15.2 +/- 4.9) weeks. The side-effect of toxin injection were including breathy voice or occasional dysphagia and aspiration. The patients with abductor spasms were less well controlled after PCA injections.</p><p><b>CONCLUSIONS</b>Spasmodic dysphonia was regarded as a neuromuscular diseases, so its diagnosis, classification, treatment and follow-up should depend on not only clinical manifestation but also EMG. Presently, for controlling the dystonic symptoms, the most effective therapy for most of those patients is local BOTOX injections. Repeated injections are required to have a stable results.</p>