Epiglottoplastili frontal anterior larenjektomi sonrası sesin akustik ve aerodinamik özelliklerinin objektif analizi
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Dosyalar
Tarih
2012
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Epiglot rekonstrüksiyonlu frontal anterior larenjektomi erken evre larenks kanserlerinde uygulanan komplikasyon düzeyi oldukça düşük, onkolojik sonuçları açısından da tatminkar bir cerrahi yaklaşımdır. Epiglottoplastili frontal anterior larenjektomi operasyonu sonrası postoperatif erken ve geç dönemde sesin ne ölçüde etkilendiğini ortaya çıkarmak ve akustik analiz parametrelerini karşılaştırmak amacıyla yapılan çalışmamızda 21 olguyu inceledik. Preop dönem, postop erken dönem ve post op geç dönem akustik ve öznel ses analizi, ses handikap indeksi, larengostroboskopik farklılıkları değerlendirdik. Çalışmamızda Maksimum Fonasyon Zamanı postoperatif dönemde anlamlı olarak düşük bulundu (preop MPT= 15,9sn postop MPT=5,5sn ). GRBAS skalasına göre postoperatif dönemde soluklu kaba bir ses elde edildiğini saptadık. Neoglottis sesinin akustik analizinde yaygın olarak kullanılan %jitter, %schimmer değerlerinin postop dönemde istatistiksel olarak arttığını saptadık ( preop % jitter= 3,5 postop % jitter= 8,1 preop % schimmer = 7,4 postop % schimmer = 14,6 ). Ses handikap indeksinde, postop dönemde en çok fonksiyonel indeksin etkilendiğini fiziksel ve emosyonel indekslerdeki artışların daha sınırlı olduğunu saptadık (preop fonksiyonel indeks= 9,29 postop erken dönem fonksiyonel indeks =14,8 preop emosyonel indeks=12,9 postop erken dönem emosyonel indeks=14,3 preop fiziksel indeks=12,7 postop erken dönem fiziksel indeks=14,6). Olguların algısal değerlendirmelerinde ise postoperatif dönemde hastaların büyük bölümünün sesini yeterli olarak değerlendirdiğini saptadık (postop erken dönem %71,4, postop geç dönem %66,6). Stroboskopik incelemelerimize göre postop dönemde longitudinal ve irregular kapanma kusurunda artış olduğunu saptadık ayrıca mukozal dalga hareketlerindeki bozulmanın da arttığını saptadık. Çalışmamız postop erken ve geç dönemde disfonik bir ses elde edildiğini gösterse de konuşma ve solunum fonksiyonlarının yeterli kalabildiği saptandı. Sonuç olarak, hastaların ses kalitesi bozuk olmakla birlikte kabul edilebilir, mesleksel ve diğer güncel aktivitelerini yürütebilir özellikte bir sese sahip oldukları bir cerrahi teknik olduğu sonucuna varılmıştır.
Abstract
Frontal anterior laryngectomy with epiglottic reconstruction performed in early stage laryngeal cancer is a surgical approach that yields satisfactory oncologic results and is associated with less complications. In our study which included 21 patients, we aimed at determining the extent of early and late onset postoperative effects of frontal anterior laryngectomy with epiglottoplasty on the voice and comparing the acustic analysis parametres. We evaluated the preoperative, early and late post operative acustic and subjective voice analysis, voice handicap index, and laryngostroboscopic differences. Postoperative Maximum Phonation time was found to be significantly short (preop MPT= 15,9sec postop MPT=5,5sec ). GRBAS scale used showed a breathy coarse voice in the postoperative period. In the jitter and schimmer measurements widely used in acustic analysis, neoglottis phonation was found to be statistically higher in the postoperative period ( preop jitter= 3,5 postop jitter= 8,1 preop schimmer = 7,4 postop % schimmer = 14,6 ). In the voice handicap index it was observed that while the functional index was the most affected in the postoperative period, increases in the physical and emotional indices were limited (preop functional index = 9,29 functional index in early postop period =14,8 preop emotional index=12,9 emotional index in early postoperative period =14,3 preop physical index =12,7 physical index in early postoperative period =14,6). In the postoperative perceptual evaluation performed most patients were found to have a voice that was sufficient (early postop period %71,4 , late postop period %66,6). In our postoperative stroboscopic studies we discovered increases in longitudinal and irregular closing defects, and also increased distortion in the mucosal wave movements. It was observed in our study that even though a disphonic voice was obtained in the early and late postoperative periods, speaking and breathing functions remained sufficient. Finally, it was concluded that with this surgical procedure patients end up with a poor quality but decent voice that does not affect their work and are able to carry out other daily activities.
Abstract
Frontal anterior laryngectomy with epiglottic reconstruction performed in early stage laryngeal cancer is a surgical approach that yields satisfactory oncologic results and is associated with less complications. In our study which included 21 patients, we aimed at determining the extent of early and late onset postoperative effects of frontal anterior laryngectomy with epiglottoplasty on the voice and comparing the acustic analysis parametres. We evaluated the preoperative, early and late post operative acustic and subjective voice analysis, voice handicap index, and laryngostroboscopic differences. Postoperative Maximum Phonation time was found to be significantly short (preop MPT= 15,9sec postop MPT=5,5sec ). GRBAS scale used showed a breathy coarse voice in the postoperative period. In the jitter and schimmer measurements widely used in acustic analysis, neoglottis phonation was found to be statistically higher in the postoperative period ( preop jitter= 3,5 postop jitter= 8,1 preop schimmer = 7,4 postop % schimmer = 14,6 ). In the voice handicap index it was observed that while the functional index was the most affected in the postoperative period, increases in the physical and emotional indices were limited (preop functional index = 9,29 functional index in early postop period =14,8 preop emotional index=12,9 emotional index in early postoperative period =14,3 preop physical index =12,7 physical index in early postoperative period =14,6). In the postoperative perceptual evaluation performed most patients were found to have a voice that was sufficient (early postop period %71,4 , late postop period %66,6). In our postoperative stroboscopic studies we discovered increases in longitudinal and irregular closing defects, and also increased distortion in the mucosal wave movements. It was observed in our study that even though a disphonic voice was obtained in the early and late postoperative periods, speaking and breathing functions remained sufficient. Finally, it was concluded that with this surgical procedure patients end up with a poor quality but decent voice that does not affect their work and are able to carry out other daily activities.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Rekonstriktif Anterior Frontal Larenjektomi, Ses Handikap İndeksi, Ses Analizi, Reconstructive Anterior Frontal Laryngectomy, Voice Handicap Index, Voice Analysis
