• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.162-169
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• 2007

현미경 하 후두 미세 수술에서 10% lidocaine 술 전 분무가 혈역학적으로 어떠한 영향을 미치는 지를 보기 위하여 대상 환자 50명을 각 25명씩 두 군으로 나누어 대조군과 10% lidocaine 분무군으로 하였다. 마취 유도 후 대조군에서는 근이완제 투여 후 3분 30초에 기관내 삽관을 시행하였으며, 연구군은 근이완제 투여 2분 후 인후두 점막과 기관내에 lidocaine 1.5 mg/kg을 분무하였고 다시 1분 30초 후에 기관내 삽관을 시행하였다. 수축기 및 이완기 혈압과 심박수를 마취 유도 전에 측정하여 기준치(T0)로 삼았으며 기관내 삽관 후 1분(T1), 3분(T2), 5분(T3), 현수 후두경 거치 후 1분(T4), 3분(T5), 5분(T6), 10분(T7)에 각각 측정하여 기록하였다. 동맥압과 심박수가 기관내 삽관후 3분까지 그리고 현수 후두경 거치 후 3분까지 대조군에 비하여 10% lidocaine 분무군에서 유의하게 낮음을 보아 기관내 삽관 전 10% lidocaine 분무는 기관내 삽관과 현수 후두경으로 인한 심혈관계 자극을 효과적으로 완화시킴을 알 수 있다.

• 대한후두음성언어의학회지
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• 제17권1호
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• pp.53-55
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• 2006

Background and Objectives: The purposes of this study are to find out clinical causes, clinical characteristics and treatment outcomes in relation to anatomical location of laryngeal cyst. Subjects and Method: A retrospective study of medical records was carried out for 170 patients with cysts on vocal cord, epiglottis, vallecula, arytenoid and aryepiglottic fold. Results: There were 83 cases of epiglottic cysts, 41 cases of vallecular cysts, 35 cases of intracordal cysts, 3 cases of arytenoid cysts and 2 cases of aryepiglottic cysts. Laryngeal cysts were more common in men than in women, and the ratio between men and women was 2:1. The age of patients ranged from 7 to 90 years, with their average age being 52 years. The most common symptom was voice change at intracordal cysts and globus sensation at vallecular and epiglottic cysts. The most common cause of intracordal cysts were voice abuse. But other location of laryngeal cysts doesn't have common causes. The average size of cysts was 0.3cm at vocal cord, 1.43cm at epiglottis, 1.4cm at vallecula, 0.9cm at arytenoid and 1cm at aryepiglottis. Recurrence was observed in 7 cases from 1 months to 18 months following the operation. Size of all recurred cysts was over the average. Conclusion: Physicians should be aware of changes in clinical patterns of laryngeal cysts according to location and have long follow-up period at large cysts after operation.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1997년도 대한이비인후과학회 종합학술대회 초록집
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• pp.116-116
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• 1997

배경 및 목적: 전신마취를 위하여 시행한 기관내 삽관은 삽관튜브와 성대내면의 접촉에 의한 압력과 마찰로 후두 미세한 손상을 주게된다. 저자들은 단기간 기관내 삽관 전,후의 음성분석을 통하여 손상의 유무와 회복을 측정할 수 있는 객관적인 음성지표를 찾아보고자 하였다. 대상 및 방법: 만성 중이염 수술시 전신마취를 목적으로 경구기관 튜브를 거치한 성인 남자 10명과 여자 15명 환자를 대상으로 수술 1일전과 술후 24시간 후 각각 "a"음을 연장 발성시켜 CSL 4300B (KAY elemetrics Corp)의 MDVP(multidimensional voice program)을 이용하여 harmonic to noise ratio(NHR), Jitter, Shimmer, Fundamental frequency를 측정 비교하였다. 결 과: 남녀 모두에서 Jitter, Shimmer는 각각 평균 0.70%에서 1.06%, 1.92%에서2.28%로 증가되는 경향을 보였으나 통계학적 유의성은 없었다. Fundamental frequency는 여자에서 평균 220Hz에서 221Hz로 남자는 125Hz에서 128Hz로 변화를 보이지 않았고 harmonic to noise ratio(NHR)또한 평균 0.11로 수술 전, 후 변화를 관찰할 수 없었다. 결 론: 이상의 결과로 2내지 6시간의 단기간 삽관으로 인한 성대의 손상은 경미하여 24시간 이내에 회복되는 것으로 판단된다. 향후 6시간 이상의 기관내삽관이나 수일이상의 장기간 삽관후의 음성지표의 측정등의 연구가 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제39권11호
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• pp.815-821
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• 2006

배경: 경동맥 내막절제술은 심한 경동맥 협착증이 있는 환자에서 발생 가능성이 높은 뇌졸중을 예방하는 데 효과적인 것으로 알려져 있으나 술 후 사망이나 뇌졸중 등의 심각한 합병증을 유발할 수 있다. 이에 저자들은 경동맥 협착증에 대한 수술적 치료의 결과를 분석하여 향후 수술의 합병증을 줄이고자 본 연구를 시행하였다. 대상 및 방법: 1996년 2월부터 2004년 7월까지 경동맥 협착증으로 한 명의 술자에 의해 경동맥 내막절제술을 시행 받은 74명(76예)의 의무기록을 후향적으로 분석하였다. 결과: 남자가 64명, 여자가 10명이었고 평균연령은 63.6세($40{\sim}77$세)였다. 경동맥 내막절제술만을 시행한 경우가 63예, 내막절제술과 함께 패취를 이용하여 경동맥 성형술을 시행한 경우가 8예, 내막절제술과 함께 경동맥의 일부를 절제한 후 단단 문합한 경우가 5예였다. 수술 중 동맥내 션트는 29예에서 사용되었다. 총경동맥과 외경동맥을 겸자한 후의 평균 내경동맥 역류압은 뇌파의 허혈성 변화가 있었던 25예(A군)의 경우 $23.48{\pm}10.04$ mmHg이었고, 뇌파의 허혈성 변화가 없었던 51예(B군)의 경우 $47.16{\pm}16.04$ mmHg이었다. 두 군 간의 내경동맥 역류압의 평균치는 통계학적으로 차이가 없었으나 (p=0.095) 뇌파의 허혈성 변화가 나타난 환자의 내경동맥 역류압은 모두 40 mmHg 이하였다. 내경동맥 역류압에 관계없이 뇌파의 허혈성 변화가 없으면 동맥내 션트를 시행하지 않고 수술하였다. 합병증은 일시적인 설하신경 마비 4예, 기존의 뇌경색 부위에 발생한 뇌출혈 2예, 경미한 뇌경색 1예, 봉합 부위의 혈액 누출에 의한 혈종 1예, 술 중 과도한 견인에 의해 유발된 것으로 생각되는 후두 부종에 의한 상기도 폐쇄 2예였다. 기존의 뇌경색 부위에 발생한 뇌출혈 2예 중 1예는 응급 수술을 시행한 경우로 뇌출혈이 심해 보존치료 도중 사망하였다. 결론: 경동맥 내막절제술은 수술 사망률이 낮은 비교적 안전한 수술 방법이다. 허혈성 뇌손상을 예방하기 위해 사용되는 동맥내 션트는 내경동맥 역류압보다는 뇌파의 허혈성 변화 여부에 따라 사용되어야 한다고 생각한다. 후두 부종을 예방하기 위해 수술 중 과도한 견인을 피하고 수술 직후 혈압을 엄격히 관리해야 하며, 후두 부종이 의심되면 작은 구경의 튜브를 이용한 기관 삽관이나 응급 기관절개술 등을 통하여 신속하게 기도를 확보해야 한다.

• 대한후두음성언어의학회지
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• 제20권2호
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• pp.118-125
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• 2009

Bilateral vocal fold immobility (BVFI) is a challenging condition which may result from diverse etiologies including vocal fold paralysis, synkinesis, cricoarytenoid joint fixation, and interarytenoid scar. Most patients present with dyspnea and stridor, but sometimes with a breathy dysphonia. Careful history taking, laryngoscopic evaluation under general anesthesia or awaken status, laryngeal EMG, and imaging studies with CT and/or MRI are helpful for providing a precise diagnosis and planning appropriate managements. In children, congenital neurological disorder is one of the most common etiologies, and spontaneous recovery has been reported in more than 50% of cases. Therefore, observation for more than 6 months while securing the upper airway with tracheostomy if needed is a generally accepted rule before deciding any destructive procedure to be undertaken. In children with advanced posterior glottic stenosis, laryngotracheal reconstruction with rib cartilage graft should be considered. In contrast to children, BVFI most commonly occurs as sequalae of surgical complication in adults. Diverse static or dynamic procedures can be applied; posterior cordotomy, vocal fold lateralization, endoscopic or open arytenoidectomy, arytenoid abduction, and reinnervation, electrical laryngeal pacing, which need to be carefully selected according to each patient's needs and pathophysiology of BVFI.

• 대한후두음성언어의학회지
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• 제11권1호
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• pp.20-27
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• 2000

To determine what is the change of pre and postoperative voice and image analysis parameters and correlations between them, videostroboscopy was analyzed in each 18 patients with unilateral vocal cord paralyses or vocal polyps before and after the surgery from November, 1996 to April, 1999. The correlation between acoustic and aerodynamic parameters was investigated. The software-Videolink and $\pi$-View(Mediface Co, Seoul, Korea)-was used in a quantitative analysis. In unilateral vocal cord paralysis, the glottic angle is well correlated with maximum phonation time, jitter and shimmer preoperatively. The postoperative glottic angle is also correlated with preoperative maximum phonation time. In patients with the vocal polyp, the chink is postoperatively decreased, but the size of the chink and the polyp is not correlated with pre and postoperative voice analysis parameters. These findings reveal that glottic an and vocal fold angle are good indicators of e postoperative glottic configuration in unilateral vocal cord paralysis. Vocal fold ratio is also a useful indicator that represents the length of vocal folds. We consider that the computerized analysis through videostroboscopy is one of objective diagnostic methods in many voice disorders if we can measure a distance between the telelaryngoscope and vocal folds.

• 대한후두음성언어의학회지
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• 제17권2호
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• pp.146-148
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• 2006

Spasmodic dysphonia is a voice disorder characterized by involuntary voice breaks during speech. Adductor spasmodic dysphonia is most common and characterized by strained and strangled voice breaks. The current standard of treatment of therapy for adductor spasmodic dysphonia is chemodenervation of thyroarytenoid muscle with botulinum toxin(Botox). However, Botox is a temporary treatment with each injection lasting approximately 3 months on average and require repeated injections. In this study, we report our experience with surgical treatment for adductor spasmodic dysphonia. In this procedure, the thyroarytenoid branch and lateral cricoarytenoid branch of recurrent laryngeal nerve is selectively denervated unilaterally, and its distal nerve stump of thyroarytenoid branch is reinnervated with branch of the usa cervicalis nerve. And lateral cricoarytenoid muscle partial myotomy was done unilaterally. After 6 months of treatment, voice fluency had improved and no period of breathiness or dysphagia was noted.

• 대한후두음성언어의학회지
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• 제20권1호
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• pp.11-16
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• 2009

OPD based laryngeal procedures offers a new avenue to the modern laryngologist, incorporating new technology in the office setting. With the development of flexible fiberoptic endoscopes, compact video system, and short acting anesthetics and sedatives allow these procedures. The success or failure of procedures are depend on excellent topical anesthesia. An inadequately anesthetized patient is apt to be uncomfortable, anxious and hyperresponsive and therefore unlikely to tolerate the procedure. On the other hand, a patient who is well informed, reassured, and thoroughly anesthetized can complete procedures. Therefore, optimal anesthesia is obligatory for excellent surgical results. The phonosurgeon should choose the anesthetic and sedative agents based on duration of action, time of onset of action, and any medical contraindications that the patient may have. And should be familiar with the properties and interaction of the agents used, as well as the signs of toxicity.

• 대한후두음성언어의학회지
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• 제16권2호
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• pp.146-151
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• 2005

Objectives: Prospective study of quality of life in patients underwent microlaryngeal surgery for dysphonia was performed. Materials and Methods : 51 patients with dysphonia took part in the study, and patients with malignancies or functional voice disorder were excluded. Patients were asked to complete the SF-36 questionnaire before surgery and within 6-12 months after surgery. Preoperative and postoperative SF-36 scores were compared with data on 46 age-matched healthy controls. Results The most of SF-36 subscale scores showed significantly improvement after surgery, except of PF (physical functioning) and MH (mental health). Preoperative scores had significantly poorer than the normal controls on 6 subscales, but there is no statistically significant differences between postoperative scores and normal controls on 5 subscales. Conclusion In the study, patients with organic voice disorder show improvement in quality of life after microlaryngeal surgery.

• 대한후두음성언어의학회지
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• 제26권2호
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• pp.97-100
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• 2015

Benign vocal fold lesions, such as vocal nodules, polyps and Reinke's edema, usually result from chronic voice overuse. Conservative management such as voice therapy and pharmacotherapy are used as the primary treatment techniques. The main purpose of voice therapy is to identify and reduce voice misuse to achieve the optimal voice. But complete resolution may not be possible in all patients after voice therapy. Furthermore, some patients with voice-related occupations, voice rest and voice therapy are sometimes difficult, which makes it hard to carry out the treatment. When conservative therapy is ineffective, laryngeal microsurgery can be performed under general anesthesia. However, potential complications following laryngeal suspension and violation of the layered structure of the vocal fold during surgery should be considered before surgery. In recent decades, emerging literatures have demonstrated the potential usefulness of vocal fold steroid injection as an alternative treatment option for benign vocal fold lesions. The most advantageous feature of vocal fold steroid injection is the maintenance of regional anti-inflammatory effects while preventing the potential systemic adverse effects of the steroid. Many non-surgical treatment methods can be conducted using different approaches in the office setting. It can be applied as an alternative treatment modality for the management of various benign vocal fold lesions.