[Progress of the laryngeal framework surgery].

Isshiki systematically developed thyroplasty in the 1970 s. Based on Isshiki's classification of thyroplasty, laryngeal framework surgery was classified by the Phonosurgery Committee of the European Laryngological Society in 2001. Then laryngeal framework surgery became more systematic and standardized, and made new progress in clinical applications and basic theoretical research. This article mainly expounds new progress in laryngeal framework surgery over the last five years.

Current trends of balloon laryngoplasty in Thailand.

OBJECTIVE: To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand. STUDY DESIGN: Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices. SUBJECTS AND METHODS: Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions. RESULTS: Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%). CONCLUSIONS: Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

[Treatment of glottal gap]. / Behandlung von Glottisschlussinsuffizienzen.

Glottal gaps can be either physiological or pathological. The latter are multifactorial, predominantly organic in origin and occasionally functional. Organic causes include vocal fold paralysis or scarring, as well as a deficiency or excess of tissue. In addition to loss of the mucosal wave, the degree of hoarseness is primarily determined by the circumferential area of the glottal gap. It is thus important to quantify the extent of glottal insufficiency. Although a patient's symptoms form the basis for treatment decisions, these may be subjective and inadequately reflected by the results of auditory-perceptual evaluation, voice analysis and voice performance tests. The therapeutic approach should always combine phonosurgery with conventional voice therapy methods. Voice therapy utilises all the resources made available by the sphincter model of the aerodigestive tract and knowledge on the mechanism of voice production. The aim of phonosurgery is medialization, reconstruction or reinnervation by injection laryngoplasty or larynx framework surgery. These different methods can be combined and often applied directly after vocal fold surgery (primary reconstruction). In conclusion, the techniques described here can be effectively employed to compensate for glottal gaps.

[Vocal fold scars: pathogenesis, diagnosis, therapy]. / Stimmlippennarben: Pathogenese, Diagnostik, Therapie.

Scarring of the vocal folds leads to a deterioration of the highly complex microstructure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite considerable progress in the understanding of the underlying pathophysiology, treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Decisive for successful treatment is an individual, multidimensional concept that comprises the whole armamentarium of surgical and nonsurgical (e.g. voice therapy) modalities. The chosen phonosurgical method is determined by the main clinical feature: medialization techniques for treatment of glottic insufficiency, or epithelium-freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments include treatment with angiolytic lasers [pulse dye laser, PDL; potassium titanyl phosphate (KTP) laser], or techniques of tissue engineering. However, despite promising results with in vitro experiments, animal studies and first clinical trials, application in clinical routine has not yet been achieved.

[Reinnervation and neurostimulation of the larynx]. / Reinnervation und Neurostimulation des Kehlkopfs.

Dynamic rehabilitation of vocal fold paralysis (VFP) should receive more emphasis in the future. In unilateral immobility with signs of atrophy and wide glottal gap, non-selective reinnervation with ansa cervicalis may become an alternative to augmentation and thyroplasty. For bilateral VFP progress has been made in the concepts of selective reinnervation and neurostimulation (pacing). These new therapies have the potential to restore near normal respiration-without compromising the voice quality-and may contribute to the development of larynx transplantation surgery.