김한수 외 Type I Type IAA Type III AA IM Type IV Fig. 1. Kinds of procedures. Type I thyroplasty was the most commo

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1 KISEP Head and Neck Korean J Otolaryngol 2005;48:78-83 음성장애에 대한 음성외과 수술 197예에 대한 임상적 고찰 이화여자대학교 의과대학 이비인후과학교실, 1 연세대학교 의과대학 이비인후과학교실, 2 음성언어의학연구소 2 김한수 1 김광문 2 최홍식 2 임재열 A Clinical Review on 197 Cases of Phonosurgery Han Su Kim, MD 1, Kwang-Moon Kim, MD 2, Hong-Shik Choi, MD 2 and Jae-Yol Lim, MD 2 1 Department of Otolaryngology, Ewha Womans University, Seoul; and 2 Department of Otorhinolaryngology, The Institute of Logopedics & Phoniatrics, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Background and Objectives:The objectives were to analyze the results of the laryngeal framework surgery (LFS) in one institute during 12 years. We reviewed the present position of LFS in the phonosurgery field and discussed the prospects for this type of surgery in the future. Subjects and Method:One hundred seventy nine charts of patients who underwent LFS in Yongdong Severance hospital from 1992 to 2003 were reviewed. Types of procedures were made according to the classification/ nomenclature of European Laryngological Society. Results:One hundred ninty seven operations had been performed during 12 years in 179 patients. Type I thyroplasty was the most common procedure (28.9%). Type I thyroplasty+arytenoid adduction (26.4%), Type III thyroplasty (16.8%), Arytenoid adduction (15.2%), Injection medialization (11.2%), Type IV thryroplasty (1.5%) followed in the order of most commonly operated choices. Of 197 cases, 18 cases were revision. There was only one major complication (dyspnea). A variety of dysphonias, which include vocal fold paralysis (71.5%), various pitch problems (mutational dysphonia (14%), androphonia (1.1%)), glottal insufficiency (12.8%), and some cases of spasmodic dysphonia (0.6%), had been treated with LFS. Conclusion:Laryngeal framework surgery is a new type of surgery that aims to improve the voice by restructuring the laryngeal framework. This type of surgery has become increasingly popular, because it has been found to be safe and effective. (Korean J Otolaryngol 2005;48:78-83) KEY WORDS:Voice disorders Thyroplasty Treatment outcome. - 78

Otorhinolaryngology, The Institute of Logopedics & Phoniatrics, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Background and Objectives:The objectives were to analyze the results of

2 김한수 외 Type I Type IAA Type III AA IM Type IV Fig. 1. Kinds of procedures. Type I thyroplasty was the most common operated-procedure. Type Itype I thyroplasty, AAarytenoid adduction, Type IIItype III thyroplasty, IMinjection medialization, Type VItype VI thyroplasty Fig. 2. Causes of operation. Vocal cord paralysis is the most common cause for laryngeal frame work surgery. VCPvocal cord paralysis, MDmutational dysphonia, GIglottal insufficiency without VCP, ETCincluding 2 cases of androphonia and 1 case of spasmodic dysphonia. Table 1. Treatment modality of vocal cord palsy Patient number129 Table 2. Treatment modality of mutational dysphonia Operation Operation number Patient number Type III thyroplasty Operation VCP MD GI ETC Bilateral Unilateral Right Left Total Number Type I thyroplasty +Arytenoid adduction 052 Type I thyroplasty 044 Arytenoid adduction 030 Injection medialization 010 Total

Vocal cord paralysis is the most common cause for laryngeal frame work surgery.

3 후두골격성형술에 대한 임상적 고찰 - 80 Table 3. Treatment modality of glottal insufficiency Patient number23 Operation Type I thyroplasty Number Unilateral 04 Bilateral 09 Type III thyroplasty Unilateral 03 Bilateral 03 Type IV thryroplasty 01 Injection medialization 12 Total 32 Korean J Otolaryngol 2005;48:78-83

Type I thyroplasty Number Unilateral 04 Bilateral 09 Type III thyroplasty

4 김한수 외

5 후두골격성형술에 대한 임상적 고찰 82 Korean J Otolaryngol 2005;48:78-83

6 김한수 외 REFERENCES 1) Isshiki N. Phonosurgery-theory and practice. New York: Springer-Verlag;1989. p ) Friedrich G, Mahieu HF, Isshiki N. Laryngeal framework surgery: A proposal for classification and nomenclature by the phonosurgery committee of the European laryngological society. Eur Arch Otolrhinolaryngol 2001;258: ) Koufman JA. Laryngoplasty for vocal cord medialization: An alternative to Teflon. Laryngoscope 1986;96: ) Harries ML. Laryngeal framework surgery (thyroplasty). J Laryngol Otol 1997;111: ) Hirose H, Sawashima M, Yoshioka H. Clinical observation on 750 cases of laryngeal palsy. Ann Bull RILP 1981;15: ) Hong SK, Kim LS, Min YG, Lee SI, Paik MK. A clinical study on vocal cord paralysis. Korean J Otolayrngol 1986;29: ) Kim KM, Cho JI, Choi HS, Kim YH, Hong WP. The etiology and treatmentof unilateral vocal cord paralysis: A 10-year review of 210 patients. J Korean Soc Logo Phon 1995;6: ) Isshiki N, Okamura H, Ishikawa T. Thyroplasty type I (Lateral compression for dysphonia due to vocal cord paralysis or atropy). Acta Otolaryngol 1975;80: ) Von Leden H, Moore P. The mechanism of the cricoarytenoid joint. Arch Otolaryngol 1961;73: ) Isshiki N, Tanaba M, Sawada M. Arytenoid adduction for unilateral vocal cord paralysis. Arch Otolaryngol 1978;104: ) Margos NE. Type I thyroplasty: Pitfalls of modifying the Isshiki approach. How I do it. J Voice 1997;11: ) Netterville JL, Jackson CG, Civnatos F. Thyroplasty in the functional rehabilitation of neurotologic skull base surgery patients. Am J Otol 1993;14: ) Choi HS, Chung YS, Kim SG, Kim YH, Kim KM. Analysis of pre and post-operative speech in combined operation of type I thyroplasty and arytenoid adduction for unilateral vocal cord palsy. J Korean Soc Logo Phon 1998;9: ) Aronsen AE. Clinical voice disorders. 3rd ed. New York: Thieme Inc; p ) Fex B, Fex S, Shiromoto O. Acoustic analysis of functional dysphonia: Before and after voice therapy. J Voice 1993;8: ) Choi HS, Cho CH, Kim KM. A case of mutational dysphonia treated with type III thyroplasty. J Korean Logo Phon 1995;6: ) Choi HS, Kim SH, Kim YH, Lee EH, Kim KM. Comparison of the surgical results in mutational dysphonia between unilateral shortening of thyroid cartilage method and bilateral shortening of thyroid cartilage method in type III thyroplasty. J Korean Logo Phon 1996;7: ) Duranti F, Salti G, Bovani B, Calandra M, Rosati ML. Injectable hyaluronic acid gel for soft tissue augmentation. A clinical and histological study. Dermatol Surg 1998;24: ) Kim HS, Lee SE, Park TJ, Choi HS. The results of voice assessment after type IV thyroplasty in a transgender (male to female, MTF). J Korean Logo Phon 2003;14:

3) Koufman JA. Laryngoplasty for vocal cord medialization: An alternative to Teflon. Laryngoscope 1986;96:726-31. 4) Harries ML. Laryngeal framework surgery (thyroplasty).

Fig. 1. Laryngoscopic findings according to Yonekawa Fig. 2. possible etiologic factors. 2A Smoking, 2B Gastroesophageal reflux symptom, 2C Skin

Fig. 1. Laryngoscopic findings according to Yonekawa Fig. 2. possible etiologic factors. 2A Smoking, 2B Gastroesophageal reflux symptom, 2C Skin KISEP Head and Neck Korean J Otolaryngol 2000;43:873-7 라인케부종의원인및음성학적고찰 안중호 남순열 Possible Etiology and Voice Analysis of Reinke s Edema Joong Ho Ahn, MD and Soon-Yuhl Nam, MD Department of Otolaryngology,