喉頭垂直部分切除術後の声門再建法

概要

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In order to obtain a good phonatory function after glottic reconstruction following vertical partial laryngectomy, the following basic principles should be taken into consideration. 1. An adequate glottic closure should occur during phonation. 2. The top of the bulge constructed on the affected side should be located at the level of the vocal cord during phonation in order to prevent false cord vibration. 3. The surface of the bulge should be smooth. A New surgical technique has been developed so as to meet the conditions described above. The present paper describes the details of the technique. The stemohyoid muscle on the affected side is dissected 5 cm below the middle level of the thyroid cartilage. The upper part of the muscle is elevated together with the overlying fascia carefully so that the vessels and the nerve branches are preserved as much as possible. Thus a single pedicle muscle flap is constructed. The thyrohyoid muscle is detached at its origin on the thyroid cartilage and is elevated. After removal of the cancerous lesion (usually by the extended frontolateral laryngectomy or its modifications), the muscle flap is bent 90 degrees at the level of the superior margin of the cricoid cartilage and placed on the wound. The tip of the muscle flap is sutured to the posterior wall of the larynx, and the bend is sutured to the sternothyroid and the cricothyroid muscles to assure the appropriate location. The top of the muscular bulge should be located at a level slightly lower than the vocal cord on the non-affected side, because the level of the vocal cord during phonation is slightly lower than that during respiration. The wound in the larynx is then covered with a pedicle mucosal flap taken from the hypopharynx or a free mucosal graft from the lower lip. The voice after the surgery usually sounds excellent. In some cases it sounds almost normal. The details of the phonatory function will be reported elsewhere.
社団法人日本耳鼻咽喉科学会の論文

著者

平野実
久留米大学

喉頭垂直部分切除術後の声門再建法

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