Pathophysiological study of neoglottis

本研究探讨了自体空肠游离移植重建象型语音后的新咽及发音功能，并与食道语音或T-E分流患者进行了比较。利用高速数字图像记录系统对新音阶振动进行了研究。使用NAGASHIMA PS77E发声功能分析仪，同时测定发声过程中的呼气肺压和基频、声压级、平均流量（MFR）。第一组接受全喉切除术。食道入口上方的下咽黏膜起食道言语新咽的作用。新咽的粘膜表面像瓣膜一样突出并振动。在T-E分流的病人中，新舌瓣是闭合的，并且在发声时振动。第二组行喉咽食管切除术，游离空肠移植物：象型分流。空肠管腔可见黏膜振动。与食道言语不同，新咽在发音过程中保持开放。我们认为，当呼气气体通过分流器进入空肠腔时，局部粘膜被伯努利效应吸走，作为声源。第一组患者呼气肺压和MFR均较低或正常。象型语音重建组压力和MFR均处于较高水平。气道阻力，即每MFR商的呼气肺压，在大象组中很高。由于声带重建部位的管腔狭窄且有粘膜褶皱，呼气时气道阻力应较高。换句话说，由于大象组气管和新咽之间的气道狭窄，需要高呼气肺压。基于目前的结果，我们希望改进手术技术和训练方法，以更好地恢复声音。

This study was conducted to investigate the neoglottis and phonatory function after elephant type voice reconstruction using a free jejunal autograft in comparison with the patients of esophageal speech or T-E shunt. The neoglottic vibration was investigated using high-speed digital image recording System. Expiratory lung pressure during phonation was determined simultaneously with the fundamental frequency, sound pressure level, and mean flow rate (MFR), using the phonatory function analyzer NAGASHIMA PS77E.The first group underwent total laryngectomy. The hypopharyngeal mucosa above the esophageal entrance plays the role of the neoglottis of the esophageal speech. The mucosal surface of the neoglottis protrudes like a valve and vibrates. In the patient with a T-E shunt, the neoglottis is closed and vibrates during phonation.The second group underwent laryngopharyngoesophagectomy with a free jejunal graft : elephant type shunt. Mucosal vibration is seen in the lumen of the jejunum. In contrast to esophageal speech, the neoglottis remains open during phonation. We consider that when the expiratory air passes through the shunt to the jejunal lumen, the local mucosa is sucked by the Bernoulli effect to serve as a sound source.In the first group, both expiratory lung pressure and MFR were in low or normal level. In the elephant type voice reconstruction group, the pressure and MFR were in high level. The airway resistance, which is the expiratory lung pressure per MFR quotient, was high in the elephant group. Because the lumen of the voice reconstruction site is narrow and possesses mucosal folds, airway resistance should be high during expiration. In other words, a high expiratory lung pressure is required due to an airway stenosis between the trachea and neoglottis in the elephant group.Based on the present results, we wish to improve surgical techniques and training methods for better voice restoration.