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
김한수 외 - - 60 50 40 30 20 10 0 57 52 33 30 22 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. 3 140 120 100 80 60 40 20 0 129 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 25 23 VCP MD GI ETC Bilateral 13 14 Unilateral 13 11 Right 10 09 Left 03 02 Total 26 25 Number Type I thyroplasty +Arytenoid adduction 052 Type I thyroplasty 044 Arytenoid adduction 030 Injection medialization 010 Total 136 3 79
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
김한수 외 - - - 81
후두골격성형술에 대한 임상적 고찰 82 Korean J Otolaryngol 2005;48:78-83
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