PHONOSURGICAL OPTIMIZATION CRITERIA FOR SULCUS VOCALIS

有迫切和持续的需要进行研究以开发和 评价手术治疗发音障碍的疗效。特别的 兴趣是与疤痕相关的病理，目前尚无满意的治疗方法。 治疗。该项目建议为以下方面制定优化标准 声带沟瘢痕形成的声外科治疗。这将是 通过1)临床和手术试验的独特组合来实现，2) 组织学研究，3)实验室实验，4)计算机模拟。这个 实验室实验将调查两种情况下的声外科结果 切除的喉部结构，以及喉部的物理模型(例如，声带 折叠组织、沟和手术后的疤痕将由 设计用于模拟组织学特性的各种生物材料)。作为一名 沟槽深度和位置的作用，a)发音中的文档变化 阈值压力，b)振动幅度，c)声门关闭程度，d) 粘膜波速，e)粘膜波形，f)声门气流，g) 声输出；2)定量纤维和间质蛋白和 声带瘢痕和沟声带的动态黏度、弹性剪切模数 褶皱组织；3)量化粘弹性能的影响 手术前后与瘢痕和声沟相关的组织 声带振动；4)模拟和优化四种声带外科手术程序 (注射、沟切除、沟切除加注射、粘膜切片、 和甲状腺成形术)，用于矫正疤痕和声沟。这项研究， 结合临床/外科试验和系统实验室 调查非常及时，因为没有始终如一有效的治疗方法 声道以声沟著称。事实上，对这种发音障碍的治疗 是现代音响外科尚未解决的问题之一(Hirano et al，1990)。

There is critical and continuous need for research to develop and evaluate the efficacy of surgical treatment for voice disorders. Of particular interest are pathologies related to scarring for which there is no satisfactory treatment. This project proposes to develop optimization criteria for phonosurgical treatment of scarring respresented by sulcus vocalis. This will be accomplished through a unique mixture of 1) clinical and surgical trials, 2) histological studies, 3) laboratory experiments, and 4) computer modeling. The laboratory experiments will investigate phonosurgical outcomes on both an excised larynx set-up, and on a physical model of the larynx (e.g., the vocal fold tissues, the sulcus, and the surgical scarring will be represented by a variety of biomaterials designed to simulate the histological properties). As a function of sulcus depth and position, document changes in a) phonation threshold pressure, b) amplitude of vibration, c) degree of glottal closure, d) mucosal wave velocity, e) mucosal wave shape, f) glottal airflow, and g) acoustic output; 2) quantify the fibrous and interstitial proteins and the dynamic viscosity, elastic shear modulus in scarred and sulcus vocalis vocal fold tissue; 3) quantify the influence of the viscoelastic properties of the pre- and post-operative tissues associated with scarring and sulcus vocalis on vocal fold vibration; 4) simulate and optimize four phonosurgical procedures (injection, sulcus excision, sulcus excision plus injection, mucosal slicing, and thyroplasty) for correction of scarring and sulcus vocalis. This study, combining both clinical/surgical trials and systematic laboratory investigations, is extremely timely because no consistently effective treatment modality is known for sulcus vocalis. Indeed, treatment of this voice disorder is one of the unsolved problems of modern phonosurgery (Hirano et al, 1990).