PHONOSURGICAL OPTIMIZATION CRITERIA FOR SULCUS VOCALIS

迫切需要不断进行研究， 评估手术治疗嗓音障碍的疗效。特别 感兴趣是与瘢痕形成相关的病理学， 治疗该项目建议制定优化标准， 声带沟瘢痕的声外科治疗这将 通过1）临床和手术试验，2） 组织学研究，3）实验室实验，和4）计算机建模。的 实验室实验将调查声音外科手术的结果， 切除的喉装置，以及喉的物理模型（例如，声乐 褶皱组织、沟和手术疤痕将由 设计用于模拟组织学特性的各种生物材料）。作为 沟深度和位置的功能，记录a）发声的变化 阈值压力，B）振动幅度，c）声门闭合程度，d） 粘膜波速度，e）粘膜波形状，f）声门气流，和g） 声输出; 2）量化纤维和间质蛋白以及 声带瘢痕和声带沟的动态粘度、弹性剪切模量 折叠组织; 3）量化的粘弹性的影响， 与疤痕和发声沟相关的术前和术后组织 声带振动; 4）模拟和优化四种声音外科手术 （注射、沟切除、沟切除加注射、粘膜切片、 和甲状腺成形术）以矫正瘢痕和声带沟。这项研究， 结合临床/手术试验和系统实验室 调查，是非常及时的，因为没有一贯有效的治疗 已知的模态为声带沟。事实上，治疗这种声音障碍 是现代声音外科学未解决的问题之一（Hirano等，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).