Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society
Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society
复制标题
DOI：
10.1007/s00405-013-2498-9
复制
发表时间：
2013-09-01
影响因子：
2.6
通讯作者：
Gugatschka, M.
中科院分区：
文献类型：
--
作者：
Friedrich, G.;Dikkers, F. G.;Gugatschka, M.
声带瘢痕导致高度复杂的微结构恶化，振动模式连续受损，声门功能不全。由此产生的发声障碍主要表现为发声能力降低。尽管在理解潜在的病理生理学方面取得了相当大的进展，但疤痕声带的治疗仍然是喉科学和声音外科学中尚未解决的一章。成功治疗的关键是一个个体的，多维的概念，包括手术和非手术（IP语音治疗）模式的整个医疗设备。理想的方法是软化疤痕，因为降低的柔韧性和因此增加的振动刚度阻碍了振动的容易性。所选择的声外科方法由主要临床功能：用于治疗声门间隙的中间化技术，或用于改善振动特性的上皮游离技术，通常与注射增强或植入相结合。在严重的情况下，颊粘膜移植可以是一种选择。新的发展，包括治疗与抗焦虑激光，激光技术与超细切除/消融性能避免凝固（皮秒红外激光，PIRL），或组织工程技术。然而，尽管体外实验、动物研究和首次临床试验取得了令人鼓舞的结果，但尚未进入临床常规应用。
Scarring of the vocal folds leads to a deterioration of the highly complex micro-structure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite the considerable progress in understanding of the underlying pathophysiology, the treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Essential for a successful treatment is an individual, multi-dimensional concept that comprises the whole armamentarium of surgical and non-surgical (i.p. voice therapy) modalities. An ideal approach would be to soften the scar, because the reduced pliability and consequently the increased vibratory rigidity impede the easiness of vibration. The chosen phonosurgical method is determined by the main clinical feature: Medialization techniques for the treatment of glottic gap, or epithelium freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments, include treatment with anxiolytic lasers, laser technology with ultrafine excision/ablation properties avoiding coagulation (Picosecond infrared laser, PIRL), or techniques of tissue engineering. However, despite the promising results by in vitro experiments, animal studies and first clinical trials, the step into clinical routine application has yet to be taken.