Videokymographic analysis of patients after frontolateral laryngectomy with sternohyoid muscle flap reconstruction (original) (raw)
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Journal of Voice, 2010
The relative measurement of the anterior commissure synechia (S) is a crucial factor worsening voice quality and the perceptual analysis score has a strong correlation to the synechia's impact. The aim of this study is to correlate the laryngeal configuration regarding the anterior commissure synechia and its relationship with the acoustic vocal parameters. Fifteen male patients underwent frontolateral partial vertical laryngectomy and reconstruction with bipedicle sternohyoid muscle flap for the treatment of T1b/T2 glottic cancer. The patients were free of disease, and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commissure synechia and the free border of both the preserved and the reconstructed vocal folds were simultaneously performed with the acoustic analysis of the voice. We calculated the mathematical proportion between the midsagital dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold-the preserved one and that reconstructed with the bipedicle sternohyoid muscle flap. The acoustic evaluation showed an important increase in the fundamental frequency, and the values of all parameters were changed regardless of the anterior commissure synechia findings. These results suggest that the acoustic voice parameters are always changed because of the aperiodic pattern regardless of the anterior commissure synechia findings.
Vocal Function Following Frontolateral Laryngectomy
European Archives of Medical Research
The aim of this study is to evaluate smoothed cepstral peak point and laryngostrobosopic results in patients who underwent frontolateral laryngectomy (FLL). Methods: Eight patients who underwent FLL with bilateral modified radical neck dissection, and who completed at least 12 months of followup, were included. All patients underwent laryngostroboscopic evaluation at study commencement; glottal closure was examined. Voice records were taken at fundamental frequency (Fo) and smoothed cepstral peak point were analysed. Voice handicap index-10 was requested to be completed. Ten healthy individual constituted control group. Results were compared. Results: The smoothed cepstral peak points were between 1.81-2.42 in the FLL group and 4.6-6.06 in controls, a significant difference. The Fo ranged from 61 to 192.63 Hz in the FLL group and from 118.57 to 197.61 Hz in the control group, also a significant difference. Laryngostroboscopy revealed significant differences between-group in their closure. Seven patients had incomplete closure in FLL group and the entire control group had complete closure except one female patient who had posterior glottal gap (p=0.01). Voice handicap index-10 results were between 31-40 in FLL group and 8-14 in control group and also revealed a significant difference. Conclusion: FLL reduces smoothed cepstral peak point and affects the mucosal wave, reducing voice quality.
Otolaryngology–Head and Neck Surgery, 2018
Objective To determine the effect of vocal fold anterior web formation on fundamental frequency with a cadaveric excised larynx model. Study Design Experimental study with excised human larynges. Setting Academic tertiary care hospital. Subjects and Methods Sixteen freshly excised human larynges were evaluated with high-speed videoendoscopy and digital kymography during artificially produced vibration. Each larynx was assessed in 4 conditions: preoperative controls and after 25%, 33%, and 50% decreases in the vibratory portion of the vocal folds. The following parameters were evaluated: fundamental frequency, periodicity, vocal fold vibration amplitude, phase symmetry, and glottic closure. Results The mean fundamental frequencies were 208.87, 250.20, 292.37, and 342.67 Hz for preoperative controls and 25%, 33%, and 50% reductions in vibratory length of the vocal folds, respectively. Fundamental frequency increased with each increase in anterior glottic web extent, and the difference...
Journal of Voice, 2008
After the surgical treatment for early glottic carcinoma, the patients end up with voice disturbances in different grades. The aim of this study was to characterize the laryngeal configuration regarding the anterior commissure synechia and its relationship to the perceptual vocal quality. Twenty-five patients underwent frontolateral vertical partial laryngectomy and reconstruction with bipedicle sternohyoid muscle flap resulting from T1b/T2 glottic squamous cell carcinoma from January 1996 to December 2004. Of the 25 patients, 24 were male with a median age of 61 years. The patients were free of disease and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commissure synechia and the free border of both vocal folds were simultaneously performed with the perceptual analysis of the voice through GRBAS scale. We calculated the mathematical proportion between the midsagittal dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold. The higher the relative measurement of the anterior commissure synechia, the worse the overall grade of hoarseness (G) for both vocal folds (P < 0.001), the worse the roughness (R) for both vocal folds (P < 0.001), and the worse the strained quality (S) for both the reconstructed (P ¼ 0.0086) and the preserved (P ¼ 0.0026) vocal folds. These results suggest that the relative measurement of the anterior commissure synechia is a crucial factor worsening voice quality and that the perceptual analyses score has a strong correlation to the synechia's impact.
2021
Due to the lack of interventional studies on the change in sound quality of patients suffering laryngeal cancer after partial frontolateral laryngectomy and anterior TVC reconstruction using laser, we aimed to assess the extent of changes in sound quality after the correction of anterior vocal cord web by flap technique using TVC base in frontolateral laryngectomy by voice handicap index (VHI) and voice analysis factors in patients with glottic cancer. In this interventional case series study, 15 consecutive patients with laryngeal carcinoma undergoing partial frontolateral laryngectomy by laser at Hazrat Rasool Akram Hospital between 2017 and 2019 suffering anterior adhesion of vocal cords were included in the final evaluation. All patients underwent microlaryngeal flap surgery to improve sound quality. The anterior web of larynx was dissected with a 6-watt super pulse CO2 laser. The vocal analysis before and after operation showed a significantly improving vocal quality parameters...
Microanalytic acoustical voice characteristics of near-total laryngectomy
Otolaryngology - Head and Neck Surgery, 1995
Limited acoustic data are available describing vocal characteristics of individuals after near-total laryngectomy. Computer-based acoustic analyses [F o, jitter, shimmer, signal-tonoise ratio] were performed on vowel samples produced by 20 speakers who underwent near-total laryngectomy. On the basis of data obtained, the subjects who had undergone near-total laryngectomy demonstrated [I] higher than normal and more variable modal fundamental frequency values for sustained vowels; [2) increased frequency [jitter] and amplitude [shimmer] perturbation; and [3] decreased spectral noise [signal-to-noise] components. In addition, speakers who had undergone near-total laryngectomy showed an increased percentage of unvoiced sound production during their vowel productions. The large variability and general aperiodicity of the phonatory signal during vowel production suggests an ineffective laryngeal valving system with overcompensation in attempts to generate effective voice. These findings have implications for designing behavioral therapy programs to improve voice quality in speakers who receive conservation laryngectomy procedures for treatment of laryngeal carcinoma. [OTOLARYNG©L HEAD NECK SURG 1995;I 13:689-94.} Illlear-total (subtotal) laryngectomy 1-3 is a surgical procedure generally used for the treatment of more extensive glottic carcinomas (i.e., T3 or T4 lesions) and/or for pyriform sinus lesions in which postcricoid and cricopharyngeal regions are free of tumor invasion. 4 Although all surgical procedures for laryngeal malignancies vary with respect to the location, size, and extent of the tumor, s the near-total laryngectomy procedure is designed to preserve laryngeal tissue contralateral to the tumor.
Videokymography: a New High-Speed Method for the Examination of Vocal-Fold Vibrations
Otorinolaryngologie a Foniatrie
Videokymography is a new optical high-speed method for investigation of vibrations which was developed especially for examination of vocal-fold vibrations. Videokymography is based on a modified CCD video camera, which is able to work in two different modes: standard and high-speed. In the standard mode the camera works as a normal commercial video camera providing 25 images (50 interlaced fields) per second. In the high-speed mode the camera delivers images from a single selected line with a frequency of almost 8000 line images/s. The successive line images are put below each other, creating a new videokymographic image monitoring vibration of the selected part of the vocal folds in time. A foot switch makes it possible to change instantaneously between the standard and high-speed modes. Ordinary videolaryngoscopic equipment with a powerful endoscopic continuous-light source can be used for the videokymographic examination of the vocal folds. Both the standard as well as high-speed images can be recorded by means of a normal video recorder, which makes the technique cost-friendly. The method is able to objectively evaluate important parameters of the vocal-fold vibration, such as the open, opening, closing and closed phases of the vibratory cycle, propagation of mucosal waves, left-right differences in phase or amplitude, etc. Videokymography provides more detailed information on voice disorders and considerably enriches laryngostroboscopy. There is no problem for videokymography to evaluate hoarse or unstable voices in which laryngostroboscopy fails. Also, the method is able to reveal structural irregularities on the medial surface of the vocal fold (e.g., sulcus glottidis) which can easily be overlooked in laryngostroboscopy. It is demonstrated how combination of a few laryngostroboscopic and videokymographic images can shortly and efficiently summarize important anatomical, physiological/pathological and vibrational properties of the laryngeal tissues in various patients.
Structures Constituting the Sound Source After the Treatment of Early Glottic Cancer
Journal of Voice, 2011
Introduction. We indicate the exclusive radiation therapy as initial approach for T1a glottic tumors, and the frontolateral laryngectomy for the tumors staged as T1b and selected T2 glottic tumors. The videolaryngostroboscopy is a useful tool to analyze the laryngeal structural changes and compensatory motion after the therapeutic approach. Objectives. To evaluate the endolaryngeal structures of patients who participate in the vibratory sound source after the early glottic cancer treatment through the videolaryngostroboscopy. Methods. It was a retrospective transversal study in which 20 patients who underwent exclusive radiation therapy and 25 patients who underwent frontolateral laryngectomy were analyzed by means of videolaryngostroboscopy. The radiation doses ranged from 5000 to 7020 cGy in the radiation therapy group. The mucosal wave and the vibratory source components were evaluated. Results. All of the irradiated patients presented vibratory behavior, and hyperfunction was occasionally observed in four cases. The mucosal wave source was glottic in 18 cases and mixed in two cases. In the laryngectomy group, 10 supraglottic sources, 10 glottic sources, and five mixed sources were identified. Among the 10 cases of supraglottic source, eight patients presented global constriction and two patients presented medial constriction. Among the five cases of mixed source, two patients presented global constriction, one patient presented medial constriction, and one patient presented anteroposterior constriction. Regarding the number of anatomical structures presenting vibratory pattern, five patients had two structures, four patients had three structures, and one patient had four structures. Conclusion. Patients who underwent radiation therapy recruit less supraglottic structures as vibratory source than the patients undergoing vertical laryngectomy.