The Morphplogical And Acoustical Researche After Supracricoid Partial Laryngectory With Cricohyoidoepiglottopexy

Objective:The aim of this study for observing laryngeal morphology,motion characteristics and measure the anatomical changes after supracricoid partial laryngectomy with cricohyoidoepiglottopexy(SCPL-CHEP,clear and definite the basic anatomia of voice.Objectively evaluate the voice quality after operation,and explore the relationship between neolarynx anatomy and function.Methods:Choose 46 cases of patients with laryngeal cancer in 2009 June to 2014 December for SCPL—CHEP as the object of study,dynamic laryngoscope and objective acoustics were performed in all the patients,to observe the movement of laryngeal pronunciation(neoglottis closure,supraglottic situation)and collect 4 acoustic parameters(F0,jitter,shimmer,MPT).Among them 15 patients also underwent 64 slice spiral CT scan and measured 8 anatomical parameters(APH,TH,APH/TH,VCL,H,SG,SC,SG/SC).The normal anatomical parameters were compared with control group,to clear anatomical variation.Combined with clinical data and anatomic parameters,analysis of related factors may affect the shape and movement of neolarynx.Compared the difference of voice parameters in different neoglottis closure and supraglottic situation of patients,Analysis of the relationship between the anatomical parameters and voice function,To investigate related factors may affect the neolarynx phonatory function.Results:①46 patients after SCPL-CHEP were included in the study,all were male.Ranging in age from 46 to 75.2,the median age was 62 years.all the postoperative pathology were squamous cell carcinoma.T1b 13 cases,stage T227 cases,stage T3 6 cases.37 cases of glottic carcinoma,9 cases with subglottic cancer.Bilateral arytenoid cartilage was preserved in 29 patients,17 patients of resection of the arytenoid cartilage.In the operation of split reconstruction in 15 patients and 5 patients received adjuvant radiotherapy after operation.The time after operation was from 1.5 to 68 months,the median time was 11.5 months.②The anatomical measurement parameters,TH APH,VCL,H,SG,SC,SG/SC,of 15 patients after CHEP were lower than the normal control group,and the difference was statistically significant(P<0.01).③ the neoglottis completely closed in 31 cases(67.4%),insufficiency closed in 15 cases(32.6%).Supraglottic vibration in 33 cases(71.7%),13 cases(28.3%)of supraglottic structure vibration free.The Spearman ’s Analysis showed that,neoglottal closure status was positively correlated with age and subglottic lesions(r=0.313,p=0.034;r=0.592,p=0,000),and negatively correlated with the postoperative time(r=-0.446,p=0.002).TH in patients of neoglottis completive closure was less than the group of neoglottis insufficient closure,and the difference was statistically significant(p=0.029).no difference in the rest of the anatomical parameters between the groups(P>0.05).Each anatomical parameters in different groups of the supraglottic vibration had no significant difference(P>0.05).④Voice parameters of F0 and MPT in CHEP group were lower than that in normal males of the same age(p=0.019;p=0.00).Jitter and shimmer were higher than those of normal males of the same age(p=0.000;p=0.001).The Voice parameters of FO,shimmer and MPT in patients of neoglottis completive closure were higher than the insufficiency group,and the difference was statistically significant(p=0.033;p=0.003;p=0.036).The Voice.parameters of jitter and shimmer in patients of supraglottic structure vibration were significantly higher than supraglottic structure vibration free group(p=0.005;p=0.012).The linear correlation analysis showed that jitter was negatively correlated with SC(r=-0.565,p=0.028).NMPT was negatively correlated with TH,SG and SG/SC(r=-0.600,p=0.018;r=-0.522,p=0.0465;r=-0.528,p=0.043).The multiple regression analysis showed that,TH was the independent impact factors of MPT,the regression equation was NMPT=1.9890.202TH.Conclusion:①The shapes of neolarynx are great changes,the remaining tissue is less,may lead to supraglottic vibration and neoglottal insufficiency.Patient age,tumor type,time,and TH are closed glottis relevant factors,supraglottic structural vibration is closely related to postoperative radiotherapy.②supraglottic vibration and neoglottal insufficiency affect the postoperative voice quality.