• 대한후두음성언어의학회지
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• 제6권1호
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• pp.39-42
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• 1995

Surgical treatment options of symptomatic unilateral vocal fold paralysis are Teflon injection, type Ⅰ thyroplasty, and arytenoid adduction. Arytenoid adduction is preferable to type Ⅰ thyroplasty for correcting the level different that may be present between two vocal folds and the large glottal chink However there is no known therapeutic modality effective to correct the large posterior glottal chink of the vocal fold with relatively normal mobility. Recently we have experienced a case of severe large posterior glottal chink of the vocal 1314s with relatively normal mobility after thyroid lobectomy, successfully treated with type Ⅰ thyroplasty combined with arytenoid adduction.

• 대한후두음성언어의학회지
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• 제18권1호
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• pp.11-15
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• 2007

Background and Objectives: $VoCoM^{(R)}$ is a set composed of prefabricated hydroxylapatite implants and shims of various sizes that are designed for the type I thyroplasty, Authors aimed to evaluate the efficacy of $VoCoM^{(R)}$ System in type I thyroplasty. Materials and Method: Twenty three patients with unilateral vocal cord palsy were included in the study, who received type I thyroplasty with $VoCoM^{(R)}$ between May 2000 and May 2007 in St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea, Acoustic, aerodynamic and stroboscopic analyses were performed pre-and post-operatively, Subjective voice improvement was analysed by Voice handicap index, Results : Preoperative jitter was $4.68{\pm}2.46%$ and improved to $3.19{\pm}1.94%$(P<0,05), Preoperative NHR was $0.26{\pm}0.1$ and improved to $0.18{\pm}0,07$(P<0.05), Preoperative MPT was $6.16{\pm}4.9$secs improved to $9.55{\pm}4.67$secs(p<0.05), The postoperative stroboscopy revealed an effective medialization of vocal fold of all patients, Conclusion: Type I thyroplasty using $VoCoM^{(R)}$ is a efficient, safe and convenient way of vocal fold medialization at the expense of its high cost and difficulty in removal.

• 대한후두음성언어의학회지
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• 제18권1호
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• pp.7-10
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• 2007

Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. The treatment of unilateral vocal cord paralysis has a long history, marked by technical innovations and improvements. These methods typically use endoscopic injection or implants to augment the volume of the affected vocal fold. The first known treatment, reported by Brunnings in 1911, was paraffin injection. The first thyroplasty medializing the paralysed vocal cord was performed by Payr in 1915 ; here, a cartilage door-flap was created from the thyroid ala to obtain better voice quality. In the 1970s, Isshiki systematized and developed the use of the external medialization by Payr. Later he modified his original technique, and achieved safer and better results. Many other methods were introduced for external medialization during the 1980s and 1990s. There has been couple of materials using for medialization laryngoplasty: silicone bloc, cartilage, goretex (polytetrafluoroethylene), titanium, etc. Among them, silicone bloc is the most popularly used material. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralysed vocal fold. In this paper, personal experience for using silicone bloc type I thyroplasty : decision making and practical points, long-term results and complication of the procedure will be discussed.

• 대한후두음성언어의학회지
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• 제8권1호
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• pp.33-37
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• 1997

Incomplete glottic closure of vocal cord atrophy is the common cause of dysphonia. Patients with vocal cord atrophy have complaints such as dysphonia, vocal fatigue, abnormal sensation in the throat, laryngeal pain, cough or sputum like functional voice disorders. Many investigators could not confirm the pathologic laryngeal structure because of their minute pathology. But recent advancements of laryngeal examinations made the many clinicians to detect minimal laryngeal pathology and to have mind the treatment for the vocal cord atrophy. But the results were less effective than their thoughts, the reasons of ineffectiveness were not known well. Authors have found the Hyperfunctional movement of the supraglottis during phonation before and after thyroplasty type I for vocal cord atrophy. Then we have applied the combined modality treatment with thyroplaty type I and voice therapy for relieve of hypefunctional movement of the supraglottis. These options have had more imporved results.

• 대한두경부종양학회지
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• 제14권1호
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• pp.27-34
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• 1998

Objectives, Materials & Methods: To prevent deterioration of postoperative voice due to iatrogenic transection of the recurrent laryngeal nerve during the thyroid surgery, intraoperative medialization of the membranous vocal cord by type I thyroplasty together with direct epineurial neurorraphy was done on 2 cases of benign thyroid lesion. To improve the quality of voice together with complete removal of advanced thyroid carcinoma, intraoperative vocal cord medialization on the lesion side together with total thyroidectomy was done by type I thyroplasty in 2 cases and combined procedure by arytenoid adduction and type I thyroplasty in another 2 cases. Results: The resultant voice of the iatrogenic injury cases was relatively tolerable. The voice of the combined procedure was better than that of type I thyroplasty cases for the intraoperative rehabilitation cases. Not only for the preoperative evaluation of the severity of the nerve lesion but also the prognosis will be expected by use of laryngeal EMG in the cases of thyroid cacer with vocal cord palsy. Conclusion: Intraoperative simultaneous rehabilitation for the vocal cord palsy during thyroid surgery is beneficial for the patients.

• 대한후두음성언어의학회지
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• 제9권1호
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• pp.66-70
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• 1998

Background and Objectives : The managements of unilateral vocal cord palsy include type Ⅰ thyroplasty and arytenoid adduction. One type operation has been shown no satisfactory effect. We evaluated preoperative and postoperative speech of unilateral vocal cord palsy patients who received combined operation of type Ⅰ thyroplasty and arytenoid adduction to help for the management plan of unilateral vocal cord palsy patients. Materials and Methods : We reviewed the postoperative results and complication of 17 surgically treated patients of unilateral vocal cord palsy at Severance hospital from Nov. 1996 to Dec. 1997 retrospectively. They were received combined operation of type Ⅰ thyroplasty and arytenoid adduction. Their pre and post-operative speech were analyzed with MDVP(Multi-Dimension-Voice analysis Program) of CSL(Computerized Speech Lab). Results : After the operation, MPT(Maximal Phonation Time) was increased and MFR(Mean Flow Rate) was decreased in all patients. NHR(Noise to Harmonic Ratio) and VTI(Voice Turbulence Index) were decreased : liner, RAP(Relative Average Perturbation Quotient), PPQ(Pitch Period Perturbation Quotient), sPPQ(smoothed Pitch Period Perturbation Quotient), vFo(fundamental frequency Variation) were decreased : Shimmer, APQ(Amplitude Perturbation Quotient), sAPQ(Smoothed Amplitude Perturbation Qoutient), vAm(Peak Amplitude Variation) were decreased in all the patients. Conclusions : In unilateral vocal cord pals), combined operation of type Ⅰ thyroplasty and arytenoid adduction could obtain satisfactory postoperative voice. MDVP has many parameters and good method for evaluation of voice surgery.

• 대한후두음성언어의학회지
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• 제14권2호
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• pp.117-122
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• 2003

Background and Objectives : $VoCoM^{\circledR}$ is a commercialized set composed of prefabricated hydroxylapatite implants and shims of various sizes which are specially designed for the type I thyroplasty. Even though a previously published preliminary report showed that $VoCoM^{\circledR}$ is a convenient and safe product for the type I thyroplasty, further investigations or experiences are yet to be reported. Authors aimed to evaluate the efficacy of $VoCoM^{\circledR}$type I thyroplasty, and its advantage and/or disadvantage. Materials and Method : Twenty three consecutive patients with unilateral vocal cord palsy enrolled for the study, who received type I thyroplasty with $VoCoM^{\circledR}$ between July 2001 and June 2003. Acoustic, aerodynamic and stoboscopic analyses were performed prior to surgery and 1 to 3 months after surgery. Speech language pathologists evaluated their voice quality by GRBAS scale, and patients themselves reported subjective changes of their voice by visual analog scale. Results : The average time for the operation was 80 min, which is about 30 min less than other methods. Preoperative jitter was 3.25$\pm$1.65% and improved to 1.94$\pm$1.79% postoperatively (p<0.05). Preoperative shimmer was 9.72$\pm$6.56% and improved to 5.61 $\pm$3.76% (p<0.05), Maximal phonation time increased from 4.41$\pm$2.99 to 7.98$\pm$4.35 sec (p<0.05) The postoperative stroboscopy revealed an effective medialization in 91.3% of the patients. The subjective phonetic improvements were reported in 21 out of 23 patients. GRBAS scale improved from 2.71$\pm$0.46 to 1.47$\pm$1.12(p<0.05). Additional medialization with $Gore-Tex^{\circledR}$ was easily performed in two revision cases. Previously inserted $VoCoM^{\circledR}$ implant was hard to remove because of the tight integration of soft tissues around the implant. Side effects such as extrusion or foreign body reaction are not observed. $VoCoM^{\circledR}$ was relatively expensive and costed more than 10 times of $Gore-Tex^{\circledR}$. Conclusion : Prefabricated hydroxylapatitie implant($VoCoM^{\circledR}$) provides a convenient, safe and efficient way of vocal fold medialization. However it is relatively expensive and hard to remove.

• 대한후두음성언어의학회지
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• 제7권1호
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• pp.5-10
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• 1996

From October 1991 to June 1995, 4 medialization thyroplasties and I arytenoid adduction were simultaneously performed with the thyroid surgery when the unilateral recurrent laryngeal nerve was paralyzed before or during thyroidectomy. Four cases were papillary carcinoma with direct invasion to the unilateral recurrent laryngeal nerve, and one case was huge adenomatous goiter and the recurrent laryngeal nerve was incidentaly cut. Hoarseness was present preoperatively with mean duration of 15 months and aspiration was also present in three cases. After phonosurgery, voice was improved in 4 out of 5 cases and aspiration subsided in 2 out of 3 cases. In one case, hoarseness continued after total thyroidectomy and thyroplasty type I and the arytenoid adduction with planned due to posterior glottic gap of 2mm. We suggest that the thyroplasty type I or arytenoid adduction are primary phonosurgical procedures which ran be performed concomitantly with neck surgeries in the patients with paralysis of the unilateral recurrent laryngeal or vagus nerve damage during neck surgeries.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
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• pp.10.1-10
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• 1982

최근의 후두미세수술 (Laryngo-microsurgery)의 보편화와 이에 따른 음성외과학(phonosurgery)의 발달로 종전까지 성대결절이나 성대폴립등의 양성종양 절제나 반회신경 마비등예에서 진단된 성문간격 (glottic chink)을 $Teflon^{{\circledR}}$ injection등으로 치료해오던 후두경술(Laryngoscopy)하에서의 수술적 조작이 그 한계와 범위를 넘어서서 이제는 우리 나라에 있어서도 후두의 기능외과적인 측면에서 음성을 개선하려는 시도가 고조되고 있으며 특히 성대마비나 변성기발성장애 (Mutational dysphonia), 성대위축 (Vocal cord atrophy), 운동기능 항진성발성장애 (Hyperkinetic dysphonia), 성대구증(Sulcus vocalis)등을 위한 음성개선수술이 실시되고 있음은 우리나라의 음성외과학의 발전이라는 견지에서도 매우 기꺼운 일이다. 이러한 뜻에서 내시경술을 통해서 성대에 직접 수술적 조작을 가하지않고서도 성문외적으로 후두구조를 수술하여 성대의 위치와 물리적 성질을 변화시킴으로서 음성을 개선하려는 갑상연골성형술 (thyroplasty)이 성행되고 있음을 강조하고싶다. Isshiki(1974)는 이러한 thyroplasty 를 4종류로 분류하였으며 편측성 성대마비의 경우 I 형 thyroplasty (lateral compression of vocal cord) 와 IV형 thyroplasty (Lengthening of vocal cord) 가 효과적인 수술방법인데 이들 수술의 장점은 국소마취하에서 환자의 목소리를 들어가면서 lateral compression의 정도를 조정해서 시술할 수 있다는것과 갑상연골내측 연골막 밖에서 의 조작으로서 후두내 출혈이나 호흡곤란등의 위험성이 전혀 없다는 것이다. 본 교실에서는 1981 년 9월부터 1982년 3월까지 7개월간에 경험한 편측성 성대마비 7예에 대하여 국소마취하에서 thyroplasty를 시행하여 약간의 지견을 얻었기에 보고하는 바이다. 수술에 앞서서 모든 환자에게 미리 공기역학검사, 청각심리적검사, 스트로보스콥검사(stroboscopy) 및 음향분석(Sound spectrographic analysis) 을 실시하였으며 thyroplasty 시행 2 개월후에 상기한 검사를 다시 시행해서 수술전후의 음성을 비교관찰하여 다음과 같은 성적을 얻었다. 1) 공기역학검사상 최장발성지속시간 (Maximum phonation time)은 58 % 증가되었으며 이에따른 발성시호기유율 (Phonation quotient)과 평균호기유율(Mean flow rate)은 각각 58 %, 54 %로 감소되었다. 2) 청각심리적검사에서 애성의 정도가 호전되었으며 스트로보스콥검사에서도 발성시 성문간격의 개선을 보았다. 3) 음향분석도상에서 성대 진동의 주기성 (Periodicity)이 회복되었으며 특히 고주파역에서의 잡음분포가 감소되었다.

• 대한후두음성언어의학회지
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• 제15권1호
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• pp.16-20
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• 2004

Purpose : To assess perceptual, acoustic and aerodynamic measure of voice quality in patients with unilateral vocal cord paralysis before and after type I thyroplasty. Methods : The clinical records of patients operated type I thyroplasty in the Departement of otorhinoalryngolgy, Yongdong Severance hospital from November 2001 to November 2003 were reviewed. All patients uderwent a vocal function evaluation including perceptual, acoustic and aerodynamic measures of voice preoperative and on $60^{th}$ postoperative day. The perceptual and acoustic measures were obtained from recording of patients' reading a 'Sanchak' passage. The perceptual evaluation was performed by 2 speech pathologist using a 4-point rating scale. Acoustic parameters(voice range profile low(RAL), voice range profile high(RAH), average fundamental frequency(AFX), closed quotient, harmonic to noise ratio, jitter and shimmer) were investigated by Lx speech studio. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured using the Phonatory function analyzer. The maximum phonation time was also measured. The data were statistically analyzed. A paired t-test (p<0.1) was used to compare preoperative and postoperative results. And multiple regression test was used to find which parameter was most correlated to improvement of postoperative voice quality. Results : Among aerodynamic parameters, Psub $(88.11mmH_2O{\rightarrow}58.7mmH_2O)$, MPT(7.87sec${\rightarrow}$12.53sec), MFR (359.8ml/sec${\rightarrow}$161.06ml/sec) were statistically improved. AFx(205.5Hz${\rightarrow}$163.27Hz), AQx(23.9%${\rightarrow}$48.3%), RAL, RAH. Jotter and shimmer were improved. In multiple regression test, AFx and AQx was noted as the two meost correlated parameters to improvement of postoperative breathiness. But general grade of voice quality was more correlated to Psub and shimmer. Conclusion : Vocal fold medialization procedures effectively reduce glottic gap. Increasing of contact area of both vocal folds induced improvement in aerodynamic parameters and leaded stabilizing of vocal fold vibration. That effect results in improvement in acoustic parameters (shimmer, jitter, signal-to-noise ratio, voice range profile) and voice quality.