기능적 3차원 후두단층촬영의 임상적 유용성:일측성 성대마비를 중심으로

전범조,김형태,최혁기,김현수,조광재,박영학,김민식,조승호 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.2

Background and Objectives:There are many clinical procedures that are related to the evaluation of kinematic events con-cerning vocal fold vibration. However, many of these procedures are hardly applicable for precise analyses of physiological and morphological changes in vocal folds with respect to the pitch control, and vocal fold volume changes from the phonatory aspect of larynx. The purpose of this study was to examine the clinical feasibility of a new 3 dimensional image method, the functional laryngeal CT, which can provide a clear sagittal image of the vocal fold in each of the anteroposterior directions during phonation and resting state. Subjects and Method:Functional laryngeal CT was performed in 4 normal control and 2 cases of unilateral vocal fold paralysis. The subjects were instructed at resting position to produce sustained vowel phonation of thre diferent on personal computer, using the DICOM (Digital Image and Communication in Medicine) file of axial images. Results:The dynamic vocal fold 3D image that was reconstructed by serial section image during phonation showed that the vocal fold became thin and volume was decreased in relation to the increase in pitch. Typical subglotic shoulder formation and ventricular widening was noted in the high pitched tone. Conclusion:Functional 3D laryngeal CT (F3DLxCT) is an informative tol for visualizing the active changes in length, tension and mas of the vocal folds for pitch control. Furthermore, the volume defect and the level diference in the paralysed vocal fold are easily detectable with this new techinque.

편측성대마비환자에서의 성문면적파형(Glottal Area Waveform)의 정량적 측정

최홍식,김명상,최재영,안성윤,이세영,홍정표 대한후두음성언어의학회 1998 대한후두음성언어의학회지 Vol.9 No.1

Type Ⅰ thyuroplasty in conjunction with arytenoid adduction is one of the excellent techniques in the treatment of unilateral vocal fold paralysis. But perioperative objective evaluation of the patients is difficult. With the development of the videostroboscopy and image analysis program, we could quantify the Glottal Area Waveform(GAW) in patients with unilateral vocal fold paralysis and investigated the relationship between the glottal area and aerodynamic and acoustic parameters. Eight female patients who were performed type Ⅰ thyroplasty in conjunction with arytenoid adduction and 5 females with normal vocal function were involved in this study. Preoperative and postoperative videostroboscopy and vocal function study wire performed. GAW was analysed quantitatively with image analysis program (Kay Stroboscope Image analysis, KSIP) Peak Glottal Area(PGA), Baseline Offset(BO), and Closing Phase(CP) were increased in patients with unilateral vocal fold paralysis and they were reduced after the operation. Mean flow Rate (MFR) was well correlated with the PGA in normal control group and unilateral vocal fold paralysis patients. Noise to harmonic ratio(NHR) was correlated with PGA only in preoperative unilateral vocal fold paralysis patients. In conclusion quantitative measurement of the GAW is useful method in evaluation of unilateral vocal f31d paralysis patients.

기관내 삽관에 의한 전신 마취 후 발생된 성대 마비

정성민,이재연,장주애,구태완 대한후두음성언어의학회 1999 대한후두음성언어의학회지 Vol.10 No.2

Background and Objectives : Vocal fold paralysis is an unusual complication following endotracheal intubation. We experienced five cases and analyzed their causes and preventions. Materials and Methods : We reviewed 5 cases of vocal fold paralysis following general anesthesia with endotracheal intubation at Ewha Womans University Hospital from September 1997 to May 1999 retrospectively. Results : Four cases were unilateral vocal fold paralysis(3 cases were left side, 1 case was right side) and a case was bilateral vocal fold paralysis. Conclusion : Vocal fold paralysis following endotracheal intubation is the result of recurrent laryngeal nerve damage. This damage can occur as the result of compressing the anterior branch of recurrent laryngeal nerve between an inflated endotracheal tube cuff and thyroid cartilage. Prevention of this complication lies in eliminating the use of endotracheal tubes with cuff inflated unevenly, desisting from the practice of deliberately placing the cuff within the larynx, and filling the cuff with a sample of the inspired mixture of gases.

Quantitative Evaluation of Laryngeal Function in Glottal Insufficiency Animal Model for Tissue Engineering Approach

권성근,이은경,김희복,송재준,조창건,박석원 한국조직공학과 재생의학회 2013 조직공학과 재생의학 Vol.10 No.6

Injection laryngoplasty is widely used for treatment of vocal fold palsy. To test the efficacy and safety of newly developed injection materials for vocal fold augmentation, we need reliable animal model for objective evaluation of glottal insufficiency. In this study, we aimed to develop an animal model to quantitatively evaluate the histological and functional changes of the paralyzed vocal fold. Left side recurrent laryngeal nerves were identified at tracheoesophageal groove of the New Zealand white rabbits and they were resected. Endoscopic examination was performed immediately after operation and 1, 2, 4, 8, 12 week after the operation to identify left vocal fold immobility. Total laryngectomy was performed 1, 2, 4, 8, 12 weeks after the operation. We have developed the method to quantify the changes of the intralaryngeal muscles. Histologic exam revealed significant decrease in thyroarytenoid muscle volume in the paralyzed side 12 weeks after the operation. We have also developed the method to quantify the laryngeal functions by analyzing vocal fold vibration. High speed recording of induced phonation showed irregular and asymmetric movement of vocal fold in the glottal insufficiency model. Videokymographic analysis showed increased open quotient and asymmetric index compared with the normal vocal fold. This model could be used to provide fundamental changes related with vocal fold paralysis. Even more, this animal model could be utilized to test efficacy and safety of various injection materials to augment the vocal fold.

사르코이드증에 의한 일측 성대 마비 1예

이오형,방주인,이도희,조정해 대한후두음성언어의학회 2019 대한후두음성언어의학회지 Vol.30 No.1

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Vocal fold paralysis secondary to sarcoidosis is extremely rare but it can develop as a result of compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We report the case of a 56-year-old woman who presented with unilateral vocal fold paralysis and enlarged supraclavicular lymph nodes. Computed tomography of the neck revealed multiple, enlarged, and matted lymph nodes at the cervical level of IV. An ultrasound-guided core needle biopsy of the lymph node was performed, and a histopathological diagnosis of sarcoidosis was made by validating the presence of noncaseating granuloma. After implementation of steroid therapy, the patient exhibited immediate recovery from vocal fold paralysis. Although an extremely rare disease, sarcoidosis should be included in the differential diagnosis of vocal fold paralysis. Accurate diagnosis and prompt steroid treatment may reduce the morbidity of patients with vocal fold paralysis secondary to sarcoidosis.

성대 마비의 치료

이진춘(Jin-Choon Lee),성의숙(Eui-Suk Sung) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.2

Vocal fold paralysis can occur for various reasons, and vocal fold paralysis treatment is important to improve the quality of life and secure airway according to voice. There are several methods of unilateral and bilateral vocal fold paralysis; voice therapy, injection laryngoplasty, laryngeal framework surgery, reinnervation procedures, tracheostomy, arytenoidectomy, cordotomy, cordectomy, and laterofixation of vocal cord. This review paper aims to discuss the treatment principles of unilateral and bilateral vocal fold paralysis.

비디오투시연하검사의 전후면 영상을 이용한 성대마비의 평가: 증례군 보고

Kang Min Soo,Ahn Hye Joon,Choi Kyoung Hyo,Oh Byung-Mo,Lee Yoon Se,Lee Seung Hak 대한연하장애학회 2022 대한연하장애학회지 Vol.12 No.1

Introduction: Laryngoscopy has been used to diagnose vocal fold paralysis (VFP). However, there have been no re-ports of videofluoroscopic swallowing study (VFSS) as a diagnostic tool for VFP. In this study, we report three cases of VFSS with specific maneuvers to visualize VFP. The examiner asked the patients to make an ‘e’ sound about 2-3 seconds, 3 times or more during the VFSS anteroposterior (AP) view. Case presentation: A 77-year-old man with lung cancer was diagnosed with the left VFP on laryngoscopy and a de-creased movement of the left vocal fold was presented on VFSS. A 64-year-old man complained of hoarseness and aspiration signs after McKeown’s procedure. Right VFP was presented on the laryngoscopy and VFSS showed a de-creased mobility of the right vocal fold. A 56-year-old man with lung cancer visited the Department of Rehabilitation Medicine to get an evaluation for signs of aspiration. The left VFP was detected during the VFSS AP view without any finding of dysphagia. He was diagnosed with left VFP on a laryngeal exam. His symptoms per-sisted after a hyaluronic acid injection. Conclusion: These cases imply that the videofluoroscopic AP view helps the evaluation of the vocal fold movement in patients with vocal fold paralysis on laryngoscopy.

Transplantation of Autologous Chondrocytes Seeded on a Fibrin/Hyaluronic Acid Composite Gel into Vocal Fold in Rabbits: Preliminary Results

( Yoo Seob Shin ),( Jin Seok Lee ),( Jae Won Choi ),( Byoung Hyun Min ),( Jae Won Chang ),( Jae Yol Lim ),( Chul Ho Kim ) 한국조직공학·재생의학회 2012 조직공학과 재생의학 Vol.9 No.4

Injection laryngoplasty is an option for treatment of glottic insufficiency following vocal fold paralysis, vocal fold atrophy or scarring. We intended to evaluate the plausibility of autologous chondrocytes cultured with fibrin/hyaluronic acid (HA) for permanent vocal fold augmentation. Chondrocytes from rabbit auricular cartilage were expanded and cultured with fibrin/HA composite gel. 0.1 mL dosages of fibrin/HA gel with autologous chondrocytes were injected into the left vocal folds of six rabbits. Four months postoperatively, the site was evaluated endoscopically, histologically, and radiologically. None of the six rabbits showed signs of respiratory distress. Computed tomography images and endoscopic evaluation revealed sufficient augmentation volume of the injected vocal fold. Histologic data showed that the injected material did not migrate from their original insertion site. Even though the number of chondrocyte that settled down and survived in the injected site was varying in rabbits, chondrocytes successfully formed neo-cartilage at four months postoperatively in all cases. Histologically, the grafts showed no signs of inflammatory reaction and were covered with ciliated epithelium. The chondrocytes cultured with fibrin/HA could be a plausible injection material for vocal fold augmentation.

일측성 성대 마비에서 운동단위 활동전위를 이용한 정량적 후두 근전도 분석

하륜,김동영,김동현,우주현 대한후두음성언어의학회 2019 대한후두음성언어의학회지 Vol.30 No.1

Background and Objectives:Laryngeal electromyography (LEMG) is valuable to evaluate the innervation status of the laryngeal muscles and the prognosis of vocal fold paralysis (VFP). However, there is a lack of agreement on quantitative interpretation of LEMG. The aim of this study is to measure the motor unit action potentials (MUAP) quantitatively in order to find cut-off values of amplitude, duration, phase for unilateral vocal fold paralysis patients. Materials and Method:Retrospective chart review was performed for the unilateral VFP patients who underwent LEMG from March 2016 to May 2018. Patient’s demography, cause of VFP, vocal cord mobility, and LEMG finding were analyzed. The difference between normal and paralyzed vocal folds and cut-off values of duration, amplitude, and phase in MUAP were evaluated. Results:Thirty-six patients were enrolled in this study. Paralyzed vocal fold had significantly longer duration (p=0.021), lower amplitude (p=0.000), and smaller phase (p=0.012) than the normal. The cut-off values of duration, amplitude, and phase in MUAP for unilateral VFP were 5.15 ms, 68.35 μV, and 1.85 respectively. Conclusion:An analysis of MUAP successfully provided quantitative differences between normal and paralyzed vocal folds. But, additional research is needed to get more available cut-off value which is helpful to evaluate the status of laryngeal innervations.

Real-Time Light-Guided Vocal Fold Injection via the Cricothyroid Membrane in Unilateral Vocal Fold Paralysis: A Human Pilot Study

허진,차원재,Pil Geun Jang,한승훈,Ramla Talib Mohammad,정우진 대한이비인후과학회 2022 Clinical and Experimental Otorhinolaryngology Vol.15 No.3

Objectives. Vocal fold injection (VFI) via the cricothyroid (CT) membrane is used to treat various diseases affecting the vocal folds. The technical challenges of this technique are mainly related to the invisibility of the needle. Real-time light-guided VFI (RL-VFI) was recently developed for injection under simultaneous light guidance in the CT approach. Herein, we present the first clinical trial of RL-VFI, in which we investigated the feasibility and safety of this new technique in unilateral vocal fold paralysis (VFP). Methods. This prospective pilot study enrolled 40 patients, who were treated with RL-VFI for unilateral VFP between September 2020 and August 2021. Adverse events were monitored during the procedure and for 4 weeks postoperatively. The Voice Handicap Index-10, the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale, aerodynamic studies, and acoustic analyses were evaluated to compare the voice improvement after 4 weeks with the baseline values. Results. The needle tip was intuitively identified by the red light. The mean procedure time was 95.6±40.6 seconds for the initial injection, while the additional injection required 79.2±70.5 seconds. The injection was performed under light guidance without additional manipulation after the needle reached the intended point. No acute or delayed adverse events were reported. Among the 40 patients, 36 completed voice analyses after 4 weeks. Subjective and objective voice parameters, including the Voice Handicap Index-10, GRBAS scale, maximum phonation time, mean expiratory airflow, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio improved significantly after RL-VFI (P<0.05), while the expiratory volume was maintained. Conclusion. RL-VFI is feasible and safe for treating patients with unilateral VFP. This technique is anticipated to improve the precision and safety of the CT approach in the treatment of unilateral VFP. This study provides a rationale for further structured clinical studies.