Behandlung von Glottisschlussinsuffizienzen

Abstract

Glottal gaps can be either physiological or pathological. The latter are multifactorial, predominantly organic in origin and occasionally functional. Organic causes include vocal fold paralysis or scarring, as well as a deficiency or excess of tissue. In addition to loss of the mucosal wave, the degree of hoarseness is primarily determined by the circumferential area of the glottal gap. It is thus important to quantify the extent of glottal insufficiency. Although a patient's symptoms form the basis for treatment decisions, these may be subjective and inadequately reflected by the results of auditory-perceptual evaluation, voice analysis and voice performance tests. The therapeutic approach should always combine phonosurgery with conventional voice therapy methods. Voice therapy utilises all the resources made available by the sphincter model of the aerodigestive tract and knowledge on the mechanism of voice production. The aim of phonosurgery is medialization, reconstruction or reinnervation by injection laryngoplasty or larynx framework surgery. These different methods can be combined and often applied directly after vocal fold surgery (primary reconstruction). In conclusion, the techniques described here can be effectively employed to compensate for glottal gaps.

Chirurgie des Larynx – Teil 1: Benigne Läsionen

“…Operationen innerhalb des Körpers unter Sicht wurden möglich, weil erstmals ein Blick in Körperhöhlen mittels "Lichtleiter" gelang, den Anfang des 19…”

Position paper of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery and the German Society of Phoniatrics and Pediatric Audiology – Current state of clinical and endoscopic diagnostics, evaluation, and therapy of swallowing disorders in children

“…Insufficiencies of glottic closure at the membranous and/or cartilaginous part of the glottis caused by unilateral paresis and defect are permanent or transitory, partial or total [ 251 ]. They may lead to penetration and aspiration.…”

“…In this context, injection or implantation is performed laterally into the lateral part of the vocalis muscle or deeper between the thyroid cartilage and the vocalis muscle. Fat, fascia, cartilage, hyaluronic acid, hydroxyapatite, and silicone are normally used as material for augmentation [ 251 ].…”

“…After previous creation of a defined thyroid cartilage window, a displacement of the lateral vocal fold in the direction of the midline is achieved by inserting and, if needed, fixing of autologous or allogeneic material. These materials are for example autologous cartilage (septum or thyroid cartilage), Gore-Tex, titanium clips, or silicone blocs [ 251 ] (Figure 28c (Fig. 28) , Figure 29 (Fig.…”

Positionspapier der DGHNO und der DGPP – Stand der klinischen und endoskopischen Diagnostik, Evaluation und Therapie von Schluckstörungen bei Kindern und Erwachsenen

“…implantiert. Als Material zur Augmentation werden unter anderem Fett, Fas zie, Knorpel, Hyaluronsäure, Hydroxylapatit und Silikon ver wendet[254].…”