術後瘢痕声帯に対する音声改善手術の経験

Abstract

[Introduction] It has been reported that satisfactory surgical treatment is difficult to accomplish on cases with post-operative vocal fold scarring where flexibility has decreased. In the present study, the primary goal was to attain voice improvement for a professional singer, who had undergone laryngeal micro-surgery repeatedly. We removed scar tissue and performed autologous fat augmentation thereby successfully improving the wave motion of mucosa during phonation. The result of our study on the changes of acoustical analyses are reported. [The Case and the Course] The patient was a 60-year-old female folk singer. She had a history of smoking and had undergone laryngeal micro-surgery for polypoid degeneration of the vocal folds several times in the past. Mucosal depression was noted on left vocal fold. Using a stroboscope, mucosal wave motion was determined to be partially lacking on the left, and a deficiency of glottal closure was seen. In order to repair the vocal fold defect, autologous fat augmentation was performed. After the operation, her daily conversation voice had improved; however, no improvement of her singing voice was noted and mucosal defect remained. The patient was a professional singer and had a strong desire for her voice to be improved further. Subsequently, using laryngeal microscope, we tried to remove the intra-mucosal scar tissue and to inject fat tissue. Post-operatively, mucosal defect had diminished almost completely and wave motion during phonation had improved.[Summary] The results of the study suggest that the removal of scar tissue and fat augmentation seem to be effective surgical treatments for vocal fold scarring.