由喉内向外缝合针输送器械

本文介绍了一种适用于显微喉镜下操作,不需作喉裂开术,由喉内向外缝针的输送器械(见图1 a、b)及其结构和使用方法,该器械可用来治疗声带疤痕粘连和双侧性喉神经麻痹所致的喉狭窄。(一)声带疤痕粘连治疗在显微喉镜下     

声带,声门与发声

声音产生于物体的振动。人体之所以能产生各种音调变化的语言,是喉头、声带、声门、呼吸及共鸣器官协调作用的结果。本文重点叙述的是声带、声门与发声的关系以及青春期的变声与发声卫生。声带、声门在喉腔的位置喉腔上通咽腔喉部,下通气管。喉腔粘膜与咽的粘膜相延续。在喉腔侧壁的粘膜有上下两对矢状位(从前向后,左右对称)的粘膜皱襞,上方一对称室襞,两侧室襞间的裂隙称前庭裂。下方一对称声襞(也就是声带),两片声带间呈三角形的空隙称声门(又叫声门     

假声带间距对喉腔内压力分布的作用及其对发声的影响

人类的发声不仅仅依赖于声带的振动．目前,越来越多的来自临床和仿真计算的结果都表明：作为喉部一个重要的狭窄通道,假声带（false vocal fold,FVF）在语音的产生过程中发挥着重要作用．本研究利用三维喉物理模型实验系统和仿真计算方法,在3个声门角（均匀声门和收敛／发散40°）、两个最小声门直径（0．04和0．06cm）及8cm水柱跨声门压条件下,对12个假声带间距（从0．02cm变化到2．06cm）在发声过程中的作用分别进行了研究．结果表明：（i）喉腔内压力在假声带间距处于1．5～2倍声门宽度时达到最小,此时气流量达到最大（对应最小的气流阻抗）;（ii）与在没有假声带条件下一样,发散声门能够比收敛和均匀声门给出更低的压力和更大的气流;（iii）假声带的出现会在某种程度上降低声门角的作用．更重要的是,（iv）假声带的出现会使得气流分离点向更下游移动,使声门气流喷射得更远,降低整个喉腔阻抗,同时减小气流能量的分散程度,说明假声带对发声效率具有重要影响．结果表明,这些结论应该与现有的发声模型（物理的或仿真计算的）相结合,从而能够更好地理解人类发声的机制．这些结果同时也对与发声问题相关的外科和康复科学研究具有促进作用．     

激光在喉狭窄治疗中的应用：附13例报告

采用支撑喉镜、喉造口以激光治疗喉狭窄１３例,均观察１年４个月以上。包括先天性喉蹼,声带粘连,双侧喉返神经麻痹,多发性复发性喉乳头状瘤多次手术无效,喉外伤后甲状软骨及其内结构严重破坏,继发感染伴喉腔大是一肉芽生产及瘢痕形成者。     

声带及其保护

声带是人类发声的主要结构,从极轻微的声嘶到完全失声,多为声带病变或其他病因使声带的正常运动发生障碍所致。从某种程度上讲,了解声带及发音的有关知识,对提高我们预防声嘶,保护声带有一定的帮助。１　声带的结构及位置声带位于喉腔假声带（室带）下方,左右各一,由声韧带、肌肉和粘膜组成,前起甲状软骨板交角内面。间接喉镜下观察,声带呈白色带状,边缘整齐,由于其后端附着于杓状软骨的声带突,故可随声带突的运动而张开或闭合。声带张开时,出现一个等腰三角形的裂隙,称为声门裂,简称声门,空气由此进出,亦为喉部最窄处。声…     

不同部位喉黏膜间充质细胞的分离培养

目的：探讨不同部位喉黏膜间充质细胞的分离、培养方法,为喉部组织工程提供更多的可供选择的种子细胞。方法：收集临床上喉部手术病人切下的不同部位的喉黏膜,主要是会厌的背侧黏膜和声带的黏膜,各3例,共计6例。对会厌背侧的黏膜采用消化培养的方法,对声带部位的黏膜采用组织块培养法。最后通过免疫荧光染色对两种方法所获得的细胞进行鉴定,确定其来源于喉黏膜的间充质。结果：通过两种方法均可以成功获得相应部位的细胞,免疫荧光染色vimentin均呈阳性表达且CK均呈阴性表达,证明了获得的细胞确实是来源于间充质。结论：本实验成功的培养出了喉部不同部位的间充质细胞,为喉部的组织工程提供了更多的可供选择的种子细胞。     

不同部位喉黏膜间充质细胞的分离培养

目的:探讨不同部位喉黏膜间充质细胞的分离、培养方法,为喉部组织工程提供更多的可供选择的种子细胞。方法:收集临床上喉部手术病人切下的不同部位的喉黏膜,主要是会厌的背侧黏膜和声带的黏膜,各3例,共计6例。对会厌背侧的黏膜采用消化培养的方法,对声带部位的黏膜采用组织块培养法。最后通过免疫荧光染色对两种方法所获得的细胞进行鉴定,确定其来源于喉黏膜的间充质。结果:通过两种方法均可以成功获得相应部位的细胞,免疫荧光染色vimentin均呈阳性表达且CK均呈阴性表达,证明了获得的细胞确实是来源于间充质。结论:本实验成功的培养出了喉部不同部位的间充质细胞,为喉部的组织工程提供了更多的可供选择的种子细胞。     

咽喉是人体最繁忙的通道

人的咽喉是人体最繁忙的通道,经过口和咽喉,每个人一生要消耗40吨食物,吸入约35万立方米的空气。喉腔侧壁左右各有一条声带,说话时,声带振动而发出声音。如果全世界的人同时讲说,整个声能相当于一座小型发电厂的功率。     

白暨豚上呼吸道的解剖和组织学的研究

白鱀豚上呼吸道具有前庭囊、鼻额囊及前颌囊三对气囊,没有副囊和连接囊。三对囊均右大于左,其中又以前庭囊最为显著。喉由甲状软骨、环状软骨、会厌软骨及一对杓状软骨组成,从喉腔壁的组织学观察发现有室皱襞(假声带)的存在。       

白鱀豚上呼吸道的解剖和组织学的研究

白鱀豚上呼吸道具有前庭囊、鼻额囊及前颌囊三对气囊,没有副囊和连接囊。三对囊均右大于左,其中又以前庭囊最为显著。喉由甲状软骨、环状软骨、会厌软骨及一对杓状软骨组成,从喉腔壁的组织学观察发现有室皱襞(假声带)的存在。     

Sexually dimorphic laryngeal morphology in Rana pipiens

The sexually dimorphic vocal characteristics of Rana pipiens release calls suggest that there may be differences in the anatomical components of the larynx. The volumes of the arytenoid cartilage, surrounding muscle masses, vocal cords, supporting bronchial process, and the release-call amplitudes of six males and five females were measured in same-sized animals and sexual differences assessed. No qualitative differences in laryngeal morphology were observed, but all features measured except vocal cords were significantly larger in males. The implications of an increased laryngeal size are discussed in relation to differences previously observed in the vocalizations of this and other species and in relation to prior suggestions regarding the developmental basis of anuran sexual dimorphisms.     

A muscle controlled finite-element model of laryngeal abduction and adduction

A three-dimensional finite-element model was developed to simulate the complex movement of the laryngeal cartilages during vocal fold abduction and adduction. The model consists of cricoid and arytenoid cartilages, as well as the intralaryngeal muscles and vocal folds. The active and passive properties of the muscles were idealised by one-dimensional elements based on the Hill theory. Its controlling input value is a time dependent stimulation rate. Optimisation loops have been carried out for the arrangement of the individual stimulation rates. Since in vivo measurements are not feasible, the developed biomechanical model shall be used to analyse the force distribution within the laryngeal muscles during phonatory manoeuvres. Simulations of abduction and adduction in different pitches of voice lead to realistic tensions of the vocal folds. The model is a first step to analyse motional vocal fold diseases and to predict the consequences of phonosurgical interventions.     

A muscle controlled finite-element model of laryngeal abduction and adduction

A three-dimensional finite-element model was developed to simulate the complex movement of the laryngeal cartilages during vocal fold abduction and adduction. The model consists of cricoid and arytenoid cartilages, as well as the intralaryngeal muscles and vocal folds. The active and passive properties of the muscles were idealised by one-dimensional elements based on the Hill theory. Its controlling input value is a time dependent stimulation rate. Optimisation loops have been carried out for the arrangement of the individual stimulation rates. Since in vivo measurements are not feasible, the developed biomechanical model shall be used to analyse the force distribution within the laryngeal muscles during phonatory manoeuvres. Simulations of abduction and adduction in different pitches of voice lead to realistic tensions of the vocal folds. The model is a first step to analyse motional vocal fold diseases and to predict the consequences of phonosurgical interventions.     

Modelling the production of complex calls in the túngara frog (Physalaemus pustulosus)

Relatively few studies have used experimental manipulations to investigate the mechanics of vocal production in frogs and toads, even though many frogs produce complex signals with multiple components and/or nonlinearities. Modelling approaches can add to empirical studies by illuminating how various components of the vocal system interact to produce communication signals. In this study, we use bond graphs, a lumped-element modelling technique, to explore how the combination of active modulation of vocal production and the passive dynamics of a unique laryngeal structure result in the complex calls produced by males in an anuran model system. The túngara frog (Physalaemus (= Engystomops) pustulosus) produces advertisement calls with a ‘whine’ and a facultative ‘chuck’. Whines are amplitude and frequency modulated. The chuck is characterized by its spectral complexity and appears to contain a period doubling bifurcation resulting in subharmonics. In our model, we focus on how a fibrous mass attached to the vocal cords results in subharmonics in the chuck. Our models suggest that active (neural) modulation of the fibrous mass is not necessary for the transition between the spectral characteristics of the whine and chuck. Rather, it is possible that the vibratory mode of the fibrous mass and thus the vocal cords changes passively as a result of changes in airflow through the system.     

Different patterns of cytokeratin expression in the normal epithelia of the upper respiratory tract

The distribution and type of cytokeratins present in the normal human epithelia of the nasopharynx, oropharynx, tongue, palatine tonsil, epiglottis, vocal cord, and laryngeal ventricle were studied using immunohistochemical techniques and by gel electrophoresis of cytoskeletal proteins microdissected from frozen tissues. Noncornifying stratified epithelia covering the oropharynx, tongue, surface of the palatine tonsil, pharyngeal surface of the epiglottis, and vocal cord were all found to contain cytokeratins nos. 4, 5, 6, 13, 14, and 15, together with minor amounts of cytokeratin no. 19, i.e., a pattern similar to that previously reported for esophageal epithelium. The immunohistochemical reaction with KA4, an antibody specific for cytokeratins nos. 14, 15, 16, and 19, revealed reactivity confined to the basal epithelial cells of the tongue, oropharynx, pharyngeal epiglottis, and two out of five samples of vocal cords. This same antibody reacted with the entire thickness of three out of the five true vocal cords which were shown by gel electrophoresis to also contain cytokeratins nos. 16 and 17. Gel electrophoresis revealed that the pseudostratified columnar epithelium covering the laryngeal ventricle was more complex, in that it contained cytokeratins nos. 5, 13, 14, 15, and 17, which are typical of stratified epithelia, as well as cytokeratins nos. 7, 8, 18, and 19, which are characteristic of simple epithelia. This pattern is similar to that found in bronchial epithelium. The laryngeal surface of the epiglottis exhibited cytokeratins nos. 4, 5, 7, 8, 13, 14, 15, 17, 18, and 19, i.e., a pattern combining features of both esophageal- and bronchial-type epithelia. The reaction of these epithelia containing columnar cells with antibody RGE-53, which is specific for cytokeratin no. 18, revealed a staining reaction confined to the superficial columnar cells, whereas KA1 stained only the basal cells of these epithelia. The results of our study make it possible to distinguish two types of noncornifying stratified squamous epithelium, namely the 'esophageal type' which covers the tongue, oropharynx, and pharyngeal surface of the epiglottis, and another type which overlies the vocal cords and the transitional zone between the pharyngeal and laryngeal surfaces of the epiglottis. Furthermore, there appear to be variants of pseudostratified columnar epithelium, i.e., the usual bronchial type lining the laryngeal ventricle, and a type with a thicker subcolumnar cell compartment that is found on the laryngeal surface of the epiglottis. The patterns of expression of cytokeratins in the respiratory tract are compared with those of other epithelia.     

Apneic laryngeal chemoreflex and naloxone

The apneic laryngeal chemoreflex (QRL), elicited by water on the vocal cords and by mechanical stimulation (MRL) has been compared in dog. Both stimuli cause apnea, bradycardia, hypotension and constriction of the glottis. In QRL apnea predominates white in MRL bradycardia is more intense. All the components of the response decrease with naloxone at a 400 micrograms X kg-1 doses, suggesting that the reflex inhibition depends on endogenous opioids located in the respiratory centre.     

Some aspects of dimorphism and human speech

The production of human speech involves thre supralaryngeal airway filtering the acoustic energy generated by either laryngeal or noise sources. Both the supralaryngeal vocal tract and the larynx are subject to sexual dimorphism in anatomically modernHomo sapiens, yielding acoustic signals that can convey a speaker’s sex. Formant frequencies can be lower because the adult male supralaryngeal vocal tract is often longer. The fundamental frequency of phonation also can be lower because of the enlargement of the thyroid cartilage of the larynx and concomitant increases in the length and mass of the vocal cords. Secondary, learned supralaryngeal vocal tract maneuvers can also lower or raise formant frequencies. These acoustic effects yield male-female «microphonetic» dialects that are ultimately related to the average dimorphism found in the adult population. The dimorphism anatomy of the supralaryngeal vocal tract and larynx of fossil hominoids can be inferred from their skulls.     

Respiratory activities of intralaryngeal branches of the recurrent laryngeal nerve

To distinguish experimentally between motor nerve activity destined for vocal cord abductor muscles and that bound for muscles that adduct the cords, we recorded efferent activities of intralaryngeal branches of the recurrent laryngeal nerve (RLN) in decerebrate, vagotomized, paralyzed, ventilated cats. Activities of the whole RLN and phrenic nerve were also recorded. Nerve activities were assessed at several steady-state end-tidal O2 and CO2 concentrations. The nerve to the thyroarytenoid (TA) muscle, a vocal cord adductor, was only slightly active under base-line (normocapnic, hyperoxic) conditions but in most cats developed strong activity during expiration in hypocapnia or hypoxia. In severe hypocapnia, phasic expiratory TA activity persisted even during phrenic apnea, indicating continuing activity of the respiratory rhythm generator. The nerve to the posterior cricoarytenoid (PCA) muscle, the vocal cord abductor, was always active in inspiration but often showed expiratory activity as well. This expiratory activity was usually enhanced by hypercapnia and often inhibited by hypoxia. The results are consistent with previous electromyographic findings and emphasize the importance of distinguishing abductor from adductor activity in studies of laryngeal control.     

Alterations in the release calls of six European anura (amphibia) after partial or total extirpation of the vocal cords

In the interior of the larynx of Ranidae there are two sturdy vocal cords. The Bufonidae have more delicate vocal cords, and in addition paired cushions of tissue anterior to the cords and paired folds posterior to the cords.In the three ranids Rana esculenta, Rana ridibunda and Rana temporaria, partial or total extirpation of the vocal cords results in loss of voice or atypical release calls. In such remnants of calls as are retained, the frequency composition is little affected, whereas the intensity is always greatly reduced. The most severe impairment is evident in the formation of sound pulses and in the rhythmicity of the pulse sequence.In the three bufonids Bufo bufo, Bufo calamita and Bufo viridis loss of voice is a less common result of the various operations than in the ranids. The most marked deterioration follows removal of all or part of the vocal cords. The tissue cushions and the posterior folds participate, along with the vocal cords, in production of the release calls. Post-operative alterations in the release calls are therefore quite variable.