Indirect Microsurgery of the Vocal Folds - Videostroboscopy vs. Microstroboscopy

1993 ◽  
Vol 72 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Zoran Milutinović
Keyword(s):  
Laser Surgery ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Surgical Approaches ◽  
Surgical Trauma ◽  
Benign Lesions ◽  
Functional Control ◽  
Microlaryngeal Surgery ◽  
Surgical Manipulation ◽  
Vocal Fold Surgery

In spite of the great significance of direct microlaryngeal surgery (DML), the inadequacies of this technique are evident. In order to avoid surgical trauma and introduce functional control during surgery, indirect microstroboscopic (IMS) and indirect videostroboscopic surgery (IVS) of the vocal folds are advocated. Both of these meet most criteria for surgical work in this field. The aim of this work was to make a comparative study of these techniques. The study is based on 603 operations conducted for benign lesions of the vocal folds. We are of the opinion that indirect vocal fold surgery for small benign lesions has significant advantages when compared with the conventional microlaryngoscopy, including laser surgery, which was proven elsewhere. When comparing these two indirect surgical approaches, the principal advantages of IVS surgery over the IMS method are easier surgical manipulation and better view. With respect to other areas of comparison, these techniques are quite similar. As complementary methods to conventional microlaryngoscopy, we believe that both IVS and IMS surgery should be used in practice.

Use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hesham El-Halaby ◽  
Marwa M El-Begermy ◽  
Mina Zakaria Hakim
Keyword(s):  
Lamina Propria ◽  
Co2 Laser ◽  
Vocal Fold ◽  
Meta Analysis ◽  
Vocal Folds ◽  
Superficial Layer ◽  
Sufficient Evidence ◽  
Benign Lesions ◽  
Benign Vocal Fold Lesions ◽  
Microlaryngeal Surgery

Abstract Background Benign superficial lesions of vocal fold (nodule, polyp, cyst and Reinke's edema) arise from the epithelium and the lamina propria. Vocal abuse and misuse presumably lead to excessive mechanical stress and trauma in the membranous portion of vocal fold, resulting in wound formation. Wound healing leads to remodeling of the superficial layer of the lamina propria. This tissue remodeling leads to formation of benign vocal fold lesions. These lesions are classically treated by conventional microsurgery and recently by CO2 laser. The use of the CO2 laser for the surgical treatment of Minor Associated Pathological Lesions (MAPL's) is still controversial. Some preferred cold instruments, whereas others appreciate CO2 laser as a novel alternative to conventional microsurgery for benign vocal fold lesions. To summarize the reviewed literature the issue of CO2 laser versus cold instruments is still controversial and the stage is open for more studies. Aim The aim of this study is to investigate the effect of Co2 Laser versus cold instruments in the treatment of benign lesions of the vocal folds regarding voice outcome & vocal fold function. Methodology A meta-analysis study is done to assess the use of Co2 Laser versus conventional microlaryngeal surgery in treatment of vocal fold benign lesions. Results This study does not reveal any detectable differences in clinical outcomes in patients with nodules, polyps and cysts who underwent excision via CO2 laser or cold instruments. Conclusion There is no sufficient evidence to determine if conventional surgery or CO2 assisted surgery is better.

Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging

2002 ◽  
Vol 111 (10) ◽  
pp. 902-908 ◽  
Author(s):  
Renée Speyer ◽  
Pieter A. Kempen ◽  
George Wieneke ◽  
Willem Kersing ◽  
Elham Ghazi Hosseini ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Lesion Size ◽  
Voice Therapy ◽  
Benign Lesions ◽  
Objective Measurements ◽  
Significant Parameter ◽  
Surface Areas ◽  
Vocal Fold Vibration ◽  
Maximal Opening

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.

Benign Lesions of the Vocal Folds: Histopathology and Phonotrauma

1995 ◽  
Vol 104 (9) ◽  
pp. 698-703 ◽  
Author(s):  
Frederik G. Dikkers ◽  
Peter G. J. Nikkels
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Histopathologic Examination ◽  
Benign Lesions ◽  
Ultrastructural Examination ◽  
Abnormal Increase ◽  
Reinke Edema ◽  
Histopathologic Findings ◽  
Single Blind ◽  
Vocal Fold Nodules

Benign lesions of the vocal folds have various appearances. Histopathologic examination might provide the true diagnosis. Therefore, histologic slides of 74 patients (92 vocal folds) with clinically well-defined diagnoses were single-blind examined by a pathologist. Single histologic features did not differentiate between different clinical entities, but combinations make some diagnoses more likely than others. Ultrastructural examination of submucosal vessels in the three most common clinical entities (polyps, Reinke edema, and vocal fold nodules) showed an entity-unique pattern of abnormal increase of layers of basement membrane—like material. A potential pathogenetic model of benign lesions of the vocal folds is presented, employing a combination of histopathologic findings and their possible relations with various forms of trauma inducing and maintaining these lesions.

Development of Electromagnetic Stimulation System to Aid Patients Suffering From Vocal Fold Paralysis

2013 ◽  
Author(s):  
William Garret Burks ◽  
Paola Jaramillo ◽  
Alexander Leonessa
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Laryngeal Nerve ◽  
Surgical Trauma ◽  
Frequency Change ◽  
Airway Protection ◽  
Laryngeal Muscles ◽  
Electromagnetic Stimulation ◽  
Stimulation System

Vocal fold paralysis affects approximately 7.5 million Americans. Paralysis can be caused by numerous conditions, including head, neck or surgical trauma, endotracheal intubation, neurological conditions, cancer, tumors, just to mention a few. Currently, vocal fold paralysis treatment involves surgery and voice therapy. The vocal folds are composed of a three part material stretched along the larynx, which enables frequency change. Intrinsic laryngeal muscles coordinate the motion of vocal folds during respiration, vocalization, and aid in airway protection. Sensory information is carried by the Superior Laryngeal Nerve (SLN) and the Recurrent Laryngeal Nerve (RLN). Injury to the RLN results in paralysis of all laryngeal muscles excluding the cricothyroid muscle [1]. Although optimal larynx reinnervation has been extensively researched and implemented to improve voice paralysis [2], voice electrotherapy offers an alternative to effectively stimulate the larynx muscles for voice production, breathing and airway protection. One of the main causes of voice disorders is neurological in nature and causes abnormal vocal fold vibration. Of particular importance to this research is paralysis due to RLN injury, which causes acute temporary paralysis [3]. Currently, invasive electrical stimulus is used to activate muscle function; however, abnormal activation of muscle patterns causes muscles to function out of synchronization resulting in low vocal output [4]. For this reason, our work focuses on the development of an effective electromagnetic stimulation system to aid patients with unilateral vocal fold paralysis by stimulating the RLN and in turn reinnervating the adequate laryngeal muscles involved in the vocal fold motion for the purposes of sound vocalization, respiration, and airway protection. So far, a proof of principle has been developed and evaluated to assess the system’s feasibility. The preliminary experiments have been conducted using BioMetal Fibers (BMF) (Toki Corporation, Japan), which are fiber-like solid state actuators designed to contract and extend similar to muscles. BMF contracts when stimulated through a current generated in this case through an electromagnetic field.

Suspension microlaryngoscopic surgery and indirect microlaryngostroboscopic surgery for benign lesions of the vocal folds

1994 ◽  
Vol 108 (12) ◽  
pp. 1064-1067 ◽  
Author(s):  
F. G. Dikkers ◽  
A. M. Sulter
Keyword(s):  
Vocal Fold ◽  
Functional Result ◽  
Benign Lesion ◽  
Vocal Folds ◽  
Benign Lesions ◽  
Intensity Maximum ◽  
Pitch Range ◽  
Intensity Range ◽  
A Prospective Study

AbstractA prospective study was designed to compare the effects on voice capacities after either suspension microlaryngoscopic surgery or indirect microlaryngostroboscopic surgery. Patients where the clinical diagnosis 'dysphonia due to a benign lesion of the vocal fold' was made, and who could be operated in either way, entered the study. Post-operative voice evaluation was performed on 21 patients after suspension microlaryngoscopic or indirect microlaryngostroboscopic surgery. The long-term voice results following indirect microlaryngostroboscopic surgery and suspension microlaryngoscopic surgery demonstrate a statistically significant improvement for the maximum intensity, maximum dynamic intensity range, dynamic intensity range at habitual speaking pitch, and melodic pitch range. In selected cases indirect microlaryngostroboscopic surgery offers a very good functional result.

Microsurgical pressing excision technique for vocal nodules and simple epithelial hyperplasia of the vocal fold

2004 ◽  
Vol 118 (3) ◽  
pp. 223-227 ◽  
Author(s):  
Ka-Wo Lee ◽  
Wen-Rei Kuo ◽  
Kuen-Yao Ho ◽  
Feng-Yu Chiang
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Epithelial Hyperplasia ◽  
Treatment Results ◽  
Microsurgical Technique ◽  
Precise Method ◽  
Potential Risks ◽  
Vocal Nodules ◽  
Microlaryngeal Surgery ◽  
Epithelial Lesions

Precise bimanual microsurgical excision of sessile, thin benign epithelial lesions of the vocal folds can be difficult. During microlaryngeal surgery, the potential risks of over-excision and under-excision are of major concern. We introduce a microsurgical technique using horizontally-opening curved microforceps and microscissors, instead of the conventional vertically-opening microinstruments, to remove vocal nodules and simple epithelial hyperplasia. The treatment results were satisfactory, with 208 (90.8 per cent) of patients retaining a satisfactory/normal (G0) voice. No patient had a worsened voice after the procedure. This microsurgical pressing excision technique is an alternative precise method for microlaryngosurgery.

Some Aspects of Vocal Fold Bowing

1994 ◽  
Vol 103 (5) ◽  
pp. 357-362 ◽  
Author(s):  
Shinzo Tanaka ◽  
Minoru Hirano ◽  
Keichi Chijiwa
Keyword(s):  
Laser Surgery ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Age Group ◽  
Organic Lesion ◽  
Tissue Removal ◽  
Sulcus Vocalis ◽  
Thyroarytenoid Muscle ◽  
Organic Lesions

Bowing of the vocal fold frequently occurs in patients with vocal fold paralysis (VFP), those with sulcus vocalis, and those who have had laser surgery. Additionally, there are vocal folds that present bowing with no noticeable organic lesion. For the purpose of investigating the causes and mechanisms of vocal fold bowing, consecutive fiberscopic videorecordings of 127 patients with VFP, 33 with sulcus vocalis, 33 with laser surgery, and 33 with dysphonia having no clinically noticeable organic lesion were reviewed. Sixty-nine percent of the paralyzed vocal folds had bowing, and the occurrence of bowing was significantly related to the activity of the thyroarytenoid muscle as measured by electromyography. The cricothyroid activity had no significant relationship to vocal fold bowing. All vocal folds with sulcus presented with bowing. Thirty-five percent of the vocal folds that had had laser surgery had bowing. The extent of tissue removal was closely related to the occurrence of bowing. Twelve cases with no organic lesion had vocal fold bowing. Of these 12 patients, 8 were male and 9 were older than 60 years. Some aging process in the mucosa was presumed to be the cause of the bowing in this age group of patients without clinically noticeable organic lesions. Causes of vocal fold bowing in the younger group of patients without organic lesions were not determined in this study.

Mucosal Suture for the Treatment of Postoperative Vocal Fold Adhesion Following the Microlaryngeal Surgery for Papilloma

2003 ◽  
Vol 54 (3) ◽  
pp. 214-218
Author(s):  
Kentaro Sato ◽  
Makito Okamoto ◽  
Koichiro Nishiyama ◽  
Masatoshi Hirayama ◽  
Hajime Hirose
Keyword(s):  
Vocal Fold ◽  
Microlaryngeal Surgery

scholarly journals Concurrent YAP/TAZ and SMAD signaling mediate vocal fold fibrosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryosuke Nakamura ◽  
Nao Hiwatashi ◽  
Renjie Bing ◽  
Carina P. Doyle ◽  
Ryan C. Branski
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Nuclear Accumulation ◽  
Smad Pathway ◽  
Surgical Interventions ◽  
Smad Signaling ◽  
Iatrogenic Damage ◽  
Tgf Β1

AbstractVocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated with scar recurrence and/or further iatrogenic damage. Non-surgical interventions are limited, putatively related to limited insight regarding biochemical events underlying fibrosis, and downstream, the lack of therapeutic targets. YAP/TAZ integrates diverse cell signaling events and interacts with signaling pathways related to fibrosis, including the TGF-β/SMAD pathway. We investigated the expression of YAP/TAZ following vocal fold injury in vivo as well as the effects of TGF-β1 on YAP/TAZ activity in human vocal fold fibroblasts, fibroblast-myofibroblast transition, and TGF-β/SMAD signaling. Iatrogenic injury increased nuclear localization of YAP and TAZ in fibrotic rat vocal folds. In vitro, TGF-β1 activated YAP and TAZ in human VF fibroblasts, and inhibition of YAP/TAZ reversed TGF-β1-stimulated fibroplastic gene upregulation. Additionally, TGF-β1 induced localization of YAP and TAZ in close proximity to SMAD2/3, and nuclear accumulation of SMAD2/3 was inhibited by a YAP/TAZ inhibitor. Collectively, YAP and TAZ were synergistically activated with the TGF-β/SMAD pathway, and likely essential for the fibroplastic phenotypic shift in VF fibroblasts. Based on these data, YAP/TAZ may evolve as an attractive therapeutic target for VF fibrosis.

High-Speed Imaging to Study an Auto-Oscillating Vocal Fold Replica for Different Initial Conditions

2017 ◽  
Vol 09 (05) ◽  
pp. 1750064 ◽  
Author(s):  
A. Van Hirtum ◽  
X. Pelorson
Keyword(s):  
Vocal Fold ◽  
High Speed ◽  
Initial Conditions ◽  
Vocal Folds ◽  
High Speed Imaging ◽  
Human Voice ◽  
Manual Intervention ◽  
Geometrical Features ◽  
Upstream Pressure

Experiments on mechanical deformable vocal folds replicas are important in physical studies of human voice production to understand the underlying fluid–structure interaction. At current date, most experiments are performed for constant initial conditions with respect to structural as well as geometrical features. Varying those conditions requires manual intervention, which might affect reproducibility and hence the quality of experimental results. In this work, a setup is described which allows setting elastic and geometrical initial conditions in an automated way for a deformable vocal fold replica. High-speed imaging is integrated in the setup in order to decorrelate elastic and geometrical features. This way, reproducible, accurate and systematic measurements can be performed for prescribed initial conditions of glottal area, mean upstream pressure and vocal fold elasticity. Moreover, quantification of geometrical features during auto-oscillation is shown to contribute to the experimental characterization and understanding.

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