Vocal Pitch Lowering Surgery-Efficacy of Thyroplasty Type 3-

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  • 甲状軟骨形成術３型の検討
  • コウジョウ ナンコツ ケイセイジュツ 3ガタ ノ ケントウ
  • Vocal Pitch Lowering Surgery—Efficacy of Thyroplasty Type 3—

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Abstract

Thyroplasty type 3 (TP3) is a surgical technique for reducing the anteroposterior diameter of the thyroid cartilage. The operation results in relaxation of the vocal folds, a low-pitched speaking fundamental frequency (SFF), and improvement of laryngeal efficiency.<br>Major indications include treatment for non-responders to voice therapy of a high-pitched SFF associated with vocal cord atrophy or mutational voice disorder, and breathy voice caused by hypertonic vocal folds. In this study we assessed pre- and post-surgical voice, laryngeal efficiency, and surgical technique in patients who underwent TP3.<br>The 19 patients who underwent TP3 at the Isshiki Clinic, Kyoto Voice Surgical Center, between 2001 and 2006 were eligible for evaluation in this study. These included 17 males and 2 females ranging in age from 18 to 73, with a mean age of 48.7 years. Surgery was performed for diagnosis of vocal fold atrophy in 8 cases, mutational voice disorder in 4 cases, sulcus vocalis in 3 cases, a combination of vocal fold atrophy and sulcus vocalis in 2 cases, gender identity disorder in 1 case, and because the patient desired a low-pitch voice in 1 case. Pre- and post-surgical SFF were measured in all subjects, and the AC/DC ratio was calculated in the 10 subjects treated since June 2004.<br>All operations were performed under local anesthesia. TP3 was performed bilaterally in 10 cases, and unilaterally in the other 9 cases. A combination of thyroplasty type 1 and TP3 was performed in 12 cases with vocal fold atrophy and glottal slit.<br>A satisfactory voice was achieved in all patients. TP3 was performed on a total of 29 sides, with face-to-face treatment of cartilage fixation on 24 sides and by overlapping on 5 sides. The mean width of cartilage resected on the 24 sides using the face-to-face method was 2.4 mm. In the bilateral group, pre- and post-surgical SFF decreased from a mean of 43.0 semitones (196.0 Hz) before surgery to 35.4 semitones (127.8 Hz) after surgery, and in the unilateral group it decreased from 42.9 semitones (198.4 Hz) to 37.7 semitones (149.3 Hz). The mean AC/DC ratio was 36.7% before surgery and 52.1% after surgery.<br>TP3 was useful as a surgical treatment to lower pitch and resulted in voices that were satisfactory to the patients. It was also effective in improving laryngeal efficiency, since most subjects showed improvement in their AC/DC ratio. The pitch-lowering effect was greater in the bilateral group than in the unilateral group.

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