Résumé
Objective To investigate the effects of phonosurgery combined with botulinumtoxinof type A in-jection in adults with vocal nodules .Methods A total of 76 adults with diagnosis of vocal nodules were studied in this experiment .They were divided into two group according to the different treatments :the surgery group (n=40) ,and the group with the combined botulinum toxin of type A injection (n=36) .Preoperative and postoperative examinations consisted of electronic laryngoscope ,stroboscopic laryngoscope ,voice assessments of subjective and objective evaluations using GRBAS classification and voice disorder index (VHI) .The evaluation parameters were the longest phonation time (MPT) ,jitter and shimmer and dysphonia severity index (DSI) .The results from the two groups were compared .Results There were 5 cases cured ,28 cases improved and 7 cases of now effects in the surgery group .The effective rate was 82 .5％ .There were 30 cases cured and 6 cases improved in the combined in-jection group with the effective rate of 100％ .There were 22 cases with good glottis closure and 18 cases with incom-plete closure in the surgery group postoperatively ;in the combined injection group ,30 cases glottis closed well and 6 cases still closed incompletely .The differences of postoperative VHI ,MPT ,jitter ,shimmer and DSI in addition to G were significant different between the two groups .Conclusion Phonosurgery combined with botulinum toxin of type A injection is an effective way for the treatment of vocal fold nodules in adults .
Résumé
Objective@#To discuss the clinical effect of small dose of botulinum toxin injection in cricothyroid muscle and thyroarytenoid muscle on patients with incomplete bilateral recurrent laryngeal nerve paresis.@*Methods@#Six patients were selected with Ⅰor Ⅱ or Ⅲ degree of dyspnea diagnosed as bilateral recurrent laryngeal nerve injury by laryngeal electromyography, and small dose of botulinum toxin injection was performed in cricothyroid muscle and thyroarytenoid muscle as a treatment. Degree of dyspnea was assessed one month before and after the treatment, and the stroboscopic laryngoscope results, acoustic parameters and CT image of the patients were collected in the 6 patients. The relevant parameters were also collected one month before and after treatment, including the degree of dyspnea, stroboscopic laryngoscope results, acoustic parameters and CT image of the patients. The angle between bilateral vocal cords in stroboscopy at full inspiratory was calculated, acoustic parameters (F0, jitter, shimmer) were analysed, and vocal length, width and the vocal region were measured. Then, the paired t test was performed for statistical analysis between before and after one month injection, the one way analysis of variance was performed among vocal parameters in CT image.@*Result@#Botulinum toxin injection was successfully completed in the 6 patients, followed without any serious complications. The degree of dyspnea was alleviated to some extent after treatment in all 6 patients; the angle between bilateral vocal cords at the end of a deep inspiration was significantly increased (t=2.44, P<0.05) after the treatment. The changes of F0 and jitter between before and after treatment were not statistically significant (t=0.72, t=1.42, P>0.05). Shimmer was significantly decreased after treatment (t=2.61, P<0.05). Vocal fold length, width and vocal region increased with F0, there was a statistically significant difference between different F0 before injection, and there was no statistically significant difference between different F0 after injection. The follow-up time was respectively seven months, 1 year, 1 year, 18 months, 22 months and 2 years respectively.@*Conclusion@#Small dose of botulinum toxin injection in bilateral cricothyroid muscles and thyroarytenoid muscles can relieve the dyspnea caused by bilateral vocal cords paresis to some extent, accompanied without serious complications, despite the sound quality was slightly worse.
Résumé
Objective The goal of the present experimental study is to investigate effects on the injection of a-dult rabbit autologous skeletal myoblasts into the thyroarytenoid(TA)muscle after recurrent laryngeal nerve (RLN) damage and traumatic vocal cords .Methods 20 adult New Zealand white rabbits were used for the establishment of an animal model simulating the cut -off of the left recurrent laryngeal nerve and the left vocal cord trauma scar for-mation after traumatic damage .Then from the rabbits ,the sternocleidomastoid muscle cells were cultured ,separa-ted and expanded .After 12 weeks ,the 20 animals were randomly divided into group A ,group B with 10 in each group .Group A(myoblast injection group) in the left vocal cord thyroarytenoid muscle injection of myoblasts 0 .3 ml ,the right vocal cord without any treatment served as normal controls ;Group B(saline injection control group) in the left vocal cord thyroarytenoid muscle was injected with normal saline ,the right vocal cord without any treatment as normal controls ,respectively ,were observed after 12 weeks of bilateral thyroarytenoid muscle fiber diameters and vocal cord volumes .Results After 12 weeks ,Group A's left thyroarytenoid muscle injection of bilateral thyroaryten-oid muscle fiber diameter and the vocal volume size was not significantly different (P>0 .05) ,thyroarytenoid muscle fiber diameter and the vocal cord volume on Group B's injected side was significantly smaller than Group A (P<0 .05) .Conclusion The thyroarytenoid muscle injection of autologous myoblasts can effectively treat recurrent la-ryngeal nerve (RLN) injury and traumatic vocal cords .
Résumé
BACKGROUND AND OBJECTIVES: Classical concept of the laryngeal neuroanatomy has been questioned by some authors. Double innervation of some intrinsic laryngeal muscles has been suggested but controversy still exists. This study investigates the possibility of double innervation of thyroarytenoid and interarytenoid muscle and also the proportion of motor component in the external and internal branch of the superior laryngeal nerve. MATERIALS AND METHODS: Horse radish peroxidase (HRP) retrograde labeling in dogs, and choline acetyltransferase (ChAT) immunohistochemistry in feline and human laryngeal nerves were used. RESULTS: Evidences suggesting the existence of double innervation in thyroarytenoid and interarytenoid muscle and the existence of sensory component in external branch and motor component in internal branch of the superior laryngeal nerve have been observed. CONCLUSION: This new concept of the laryngeal neuroanatomy may be helpeful for understanding some of the neurologic diseases of the larynx such as spasmodic disphonia or variability of the vocal cord position in vocal cord paralysis. Further neuroanatomic and physiologic study is needed.