The Objective Evaluation Of Postoperative Laryngeal Morphology And Voice For Early Glottic Cancer

Objective:The incidence of laryngeal cancer place the second in the head and neck malignant tumors, surgery is one of the main treatments. In recent decades, partial laryngectomy has become the main treatment gradually with the development of further research for tumor and surgical techniques. The laryngeal reconstruction decides the morphological changes directly, and affect the quality of postoperative voice. At the same time, with the improvement of early laryngeal cancer cure rate, laryngeal cancer patients have not only met the cure of cancer, and the requirement for the quality of postoperative voice is increasingly improved. The purpose of this paper is to evaluate the postoperative voice and laryngeal morphological changes by objective acoustic analysis and CT evaluation of laryngeal vocal area changes to further improve the larynx resection and the postoperative voice quality of patients.Methods:(1) The object of study:33male patients with laryngeal squamous cell carcinoma of T1a or T1b at the same age group (60-70years) underwent tracheotomy and partial laryngectomy voluntarily. The laryngeal defect after resection of tumor in operation was repaired by ventricular fold pull-down combined with strip myofascial flap;(2) The objective measurement:we tested the actual voice of the patients at one day prior to operation, three months after surgery, and1year after surgery by EndoSTROB ent multi-functional diagnostic operation system from Xion company of Germany. It contained F0、Jitter、Shimmer、NNE and MPT, and with Praat software carried on the standardization of voice acoustic test. Before operation and1year after surgery, we used multilayer spiral CT to scan patients larynx, measured the anteroposterior diameter of vocal area, the distance between both sides of the vocal process, and the average thickness of soft tissue of vocal area separately;(3) Statistical analysis:The data was analyzed by the SPSS20.0statistical software.Results:(1) Third-two patients healed I incision after surgery, except one patient delayed union. All the patients successfully decannulated in postoperative1month Third-one patients were followed up for1year;(2) The results of voice acoustic analysis comparison before and after operation showed that the F0, Shimmer and MPT reduced after3months of the operation, and the difference was statistically significant T value were3.13,2.38and3.91respectively, P values were0.04,0.02and0.00.1year after surgery, Shimmer, NNE and MPT were all reduced compared with the results of preoperation. And the difference was statistically significant. T value were3.65,5.99and2.69respectively, and P values were0.02,0.00and0.01respectively;(3) The results of voice acoustic analysis at different periods after operation showed that NNE in the1year after operation reduced than the result in the3months, and the difference was significant statistical significance. T value was5.11, and P value was0.00;(4) The results of laryngeal morphological measurements comparison before and after operation showed that the anteroposterior diameter of vocal area significantly reduced after surgery. There was significant difference of statistical significance, T value was10.46and P value was0.00. The average thickness of soft tissue of vocal area was not obvious changed, and it had no statistically significant difference. T value was1.97and P value was0.058. The postoperative distance between both sides of vocal cords did not decrease obviously, and it had no statistically difference. T value was2.56and P value was0.065,Conclusions:(1) Ventricular fold pull-down combined with strip myofascial flap can be used as effective new laryngeal voice vibration body;(2) Using ventricular fold pull-down combined with strip myofascial flap to repair the laryngeal defect has little effect on postoperative laryngeal morphology, especially for changes in the respiratory department of vocal area department;(3) The patient phonetic function reduced in different levels after partial laryngectomy;(4) With the extension of time, postoperative vocal stability and glottic closure increased gradually;(5) Voice multidimensional parameters combined with throat CT measurement data can be objective and accurate assessment of the laryngeal function after partial laryngectomy.