ポリープ様声帯の手術療法

Abstract

The term “Reinke's edema” is widely used to describe varying degrees of a diffusely edematous swelling of the vocal folds. In a previous study (Yonekawa, 1988), the authors proposed a classification of the disease into three types: Type I, II, and III, which was often useful in analyzing the clinical features and evaluating the postoperative results. This disease is most common in patients above 40 years of age and has a chronic course with severe hoarseness and low-pitched voice. Many researchers have emphasized that smoking is an important causative factor. Endolaryngeal microsurgery has been the accepted treatment of this disease and some surgical techniques have been proposed recently. However, there has been little information on the efficacy of surgical techniques and no precise description of any long term follow-up investigations after surgery.In the present study the surgical techniques reported in the literature are described briefly and a new surgical procedure, the “squeezing technique” proposed by the authors' group, is reported together with the postoperative results and long term follow-up.In the squeezing technique, the mucous membrane covering the edematous swelling is removed preserving the mucoua on the free margin of the vocal fold, and the submucosal contents are squeezed out with a small cotton ball. This technique is considered to be the most appropriate for treating Type III cases.Considerable improvement was noted in terms of subjective symptoms as well as in the voice quality as measured by phonatory analysis. In Type III female cases, the fundamental frequency of the voice tended to increase markedly after surgery. At the follow-up examination, the length of time until the speaking voice could maintain stability was prolonged in Type III cases. The incidence of recurrent edema of the vocal folds was significantly greater in patients who continued to smoke after surgery than in those who stopped smoking. Voice therapy should include the prohibition of smoking after surgery.