• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.1
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• pp.71-78
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• 1998

Type Ⅰ thyuroplasty in conjunction with arytenoid adduction is one of the excellent techniques in the treatment of unilateral vocal fold paralysis. But perioperative objective evaluation of the patients is difficult. With the development of the videostroboscopy and image analysis program, we could quantify the Glottal Area Waveform(GAW) in patients with unilateral vocal fold paralysis and investigated the relationship between the glottal area and aerodynamic and acoustic parameters. Eight female patients who were performed type Ⅰ thyroplasty in conjunction with arytenoid adduction and 5 females with normal vocal function were involved in this study. Preoperative and postoperative videostroboscopy and vocal function study wire performed. GAW was analysed quantitatively with image analysis program (Kay Stroboscope Image analysis, KSIP) Peak Glottal Area(PGA), Baseline Offset(BO), and Closing Phase(CP) were increased in patients with unilateral vocal fold paralysis and they were reduced after the operation. Mean flow Rate (MFR) was well correlated with the PGA in normal control group and unilateral vocal fold paralysis patients. Noise to harmonic ratio(NHR) was correlated with PGA only in preoperative unilateral vocal fold paralysis patients. In conclusion quantitative measurement of the GAW is useful method in evaluation of unilateral vocal f31d paralysis patients.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.1
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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.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.118-122
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• 2017

Background and Objectives : In unilateral vocal fold paralysis (VFP), medialization thyroplasty (MT), arytenoid adduction (AA) and injection layrngoplasty (IL) are the most common procedures to correct phonatory problems. There is no consensus that which procedure is superior to the other for correcting the glottal insufficiency. The purpose of this study was to compare the phonatory parameters between MT, AA and AA with IL (AA+IL) in patients with unilateral VFP. Materials and Methods : This retrospective study enrolled patients from 2005 to 2016. Total 72 patients (49 male, 23 female, mean age 54.5 years) were classified into three groups ; MT (n=28), AA (n=12), and AA+IL (n=32). GRBAS scales, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), and voice handicap index (VHI)-10 and VHI-30 were preoperatively and postoperatively collected and compared between the three groups. Results : Age, gender and cause of VFP were not significantly different between the three groups. In MT and AA groups, MPT, VHI, G (overall grade) and B (breathiness) were significantly improved. In AA+IL group, jitter, shimmer, NHR, MPT, VHI, G and B were significantly improved. In analysis of differences (pre-postoperative values), ${\Delta}$ jitter (p<0.001), ${\Delta}$ shimmer (p=0.031), and ${\Delta}$ NHR (p=0.002) were significantly different and AA+IL group showed the greatest improvement. Conclusion : Analysis of voice parameters showed that all the three procedures for patients with unilateral VFP are effective in the improvement of voice ; especially in MPT, VHI-10, G and B scales. Compared to the others, AA+IL provided the better acoustic values including jitter, shimmer and NHR.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.22 no.1
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• pp.18-22
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• 2011

Laryngeal framework surgery comprises medialization laryngoplasty and arytenoid adduction. Since their introduction in the 1970s, these procedures have become standard treatments for vocal fold paralysis and glottal incompetence. However, frequency of laryngeal framework surgery is conjectured to relatively decrease along with the introduction of injection laryngoplasty. In this manuscript, indications for laryngeal framework surgery were highlighted in contrast to those of injection laryngoplasty. The authors introduced the basic concepts and principles as well as surgical techniques of laryngeal framework surgery. Even though the incidence of major and/or minor complications after laryngeal framework surgery is not high, surgeons should be well aware of its possible complications and they should be familiar with tips and know-how to avoid or cope with complications.

• Proceedings of the KSLP Conference
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• 1993.12a
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• pp.19-19
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• 1993

편측 성대마비에 대해서 Teflon 삽입술, 갑상연골성형술, 피열연골내전술 등 여러 술식이 사용되고 있다. 1993년 3월부터 1993년 10월까지 서올대학교병원 이비인후과에서는 여러 가지 원인으로 발생한 8례의 편측 성대마비에 대해서 피열연골 성형술을 시행하여 다음과 같은 결과를 얻었다. 원인으로는 특발성이 3례, 갑상선 수술에 후발한 것이 2례, 경부종괴절제수술에 후발한 것이 2례, 흉부수술에 후발한 것이 1례, 디프테리아가 1례였고, 좌측 성대마비가 5례, 우측 성대마비가 3례였다.(중략)

• Korean Journal of Head & Neck Oncology
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• v.14 no.1
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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.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.52-58
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• 1998

BACKGROUND： Aspiration is defined as the laryngeal penetration of secretions below the level of the true vocal cords. Aspiration can result in life-threatening complications, such as bronchospasm, airway obstruction, pneumonia, pulmonary abscess, sepsis, and death. The patient with high vagal palsy had significant aspiration and dysphagia OBJECTIVE： To formulate a step-by-step management paradign for the patients with high vagal palsy MATERIALS AND METHODS : The medical records of 23 patients who were diagnosed as high vagal palsy from September, 1995 to April, 1998 in Seoul National University Hospital were reviewed retrospectively. Eleven patients were managed conservatively and 12 patients were operated to treat chronic aspiration. RESULTS : The main etiologies of high vagal palsy were mass lesions of the skull base such as neurogenic tumor, pseudotumor, meningioma or nasopharyngeal carcinoma. Aspiration and dysphagia improved in 7 out of 11 patients who were managed conservatively after 2.2 months on the average. The patients who were refractory to the conservative management underwent surgery and showed improvement in 10 out of 12 patients. The employed surgical modalities were vocal cord medialization combined with cricopharyngeal myotomy in 7 patients, laryngotracheal separation in 3 patients and arytenoid adduction only in 2 patients. Two patients still had gastrostomy tube due to the persistent symptoms. Two patients had improved after surgery, but died of underlying disease. CONCLUSION : The patients with high vagal palsy are recommended to be managed conservatively for the first 2 months. If aspiration and dysphagia are persisting after conservative management, vocal cord medialization combined with or without cricopharyngeal myotomy should be considered. If failed, laryngotracheal separation or gastrostomy will be the next option based on the control of the oropharyngeal secretion.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.185-187
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• 2000

The etiology of vocal fold granuloma was identified : post-endotracheal intubation, vocal abuse, acid reflux and idiopathic. The identification of the cause or causal factor is important, since the treatment must be fundamental directed at them. Treatment have included voice therapy and antireflux measures. Surgical excision is considered in patients who do not respond to medical management. In this study, a case of vocal fold granuloma resolved who underwent injection of the affected vocal fold. Botulinum toxin type A is probably successful by decreasing the strength during adduction in the arytenoid region which, when very intense, would perpetuate the granuloma. Localized injection of this neurotoxin is promising both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy.

• Proceedings of the KSLP Conference
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• 1994.06b
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• pp.87-87
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• 1994

편측 성대마비에 의한 부전의 수술적 치료로는 그 동안 테플론주입에 의한성대내측전위술, 제1형 갑상연골성형술, 또는 피열연골내전술 등이 이용되었으며, 성대부전이 심하거나 성대높이에 차이가 있을 때는 제1형 갑상연골성형술 등에 비해 피열연골내전술이 좋은 결과를 보이는 것으로 보고되고 있다 그러나, 성대의 움직임은 있으면서 뒷쪽에 심한 성대부전(posterior glottic chink)을 보이는 경우에는 아직은 특별한 수술적인 방법이 없는 바, 저자들은 갑상선 부분절제술 후에 생긴 양쪽성대의 움직임은 있으면서 성문 뒷쪽에 심한 부전을 보인 발성장애 환자 1례에서 제1형 갑상연골성형술과 동시에 피열연골내전술을 시행하여 좋은 결과를 얻었기에 보고하는 바이다. (중략)

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.6 no.1
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• pp.27-38
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• 1995

It is well known that unilateral vocal cord paralysis is a sign of a disease and not a disease entity. In an attempt to evalute incidence of unilateral vocal cord paralysis related to varoius causes and to analyze our treatment results, the records of 210 patients seen at the Department of Otorhinolaryngology, Yongdong Severance Hospital during the 10-year period from March 1985 to March 1995 were reviewed. Fifty-three patients(25.2%) of the 210 patients with unilateral vocal cord paralysis had surgery-related causes, and intubations including tracheostomy was the most common etilogy among them. One hundred and fifty seven cases(74.8%) was not related to surgery and, among these most common cause was idiopathic. Spontaneous recovery took place in 17(8%) patients. Phonosurgery including type Ⅰ thyroplasty(n=16) and arytenoid adduction(n=10) and combination of them(n=3) yielded good results except intrafold teflon injection(n=4). These results of our series were compared to other series reported over the past decades.