人工喉Laryngeal replacement with an artificial larynx.pptVIP

Laryngeal replacement with an artificial larynx Christian Debry, MD, PhD, Agnes Dupret–Bories, MD, PhD, Nihal E. Vrana, PhD, et al Abstract laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma an artificial larynx system that can replace the laryngeal functions The patient was able to talk in a whispering fashion while the tracheostomy （气管造口）was temporarily closed allowing the patient to breathe via the upper respiratory airways while avoiding the aspiration of food. Materials A nonremovable tracheal prosthesis a nonremovable tracheal prosthesis：porous titanium at its distal extremity, sutured to the proximal（邻近） trachea A silicone tube：inserted into the tracheal prosthesis’ lumen（内腔）preventing the development of a stenotic granuloma during wound healing Materials The removable part concentric（同轴心） valve system with double openings allow air to be inhaled and exhaled implanted via endoscopy remain closed at rest, open only when solicited by respiratory airflow（micro-magnet（微磁铁）） Tracheal prosthesis implantation The proximal trachea was raised The tracheal prosthesis and the trachea’s proximal portion were joined without tension and sutured The silicon tube was inserted into the prosthesis’ lumen The upper tracheal prosthesis was sutured to the tongue’s base and temporarily closed using a cap Anterior covering：The infrahyoid（舌骨下） muscles and the clavicular heads of the sternocleidomastoid muscles（胸锁乳突肌锁骨头） posterior part ： pharyngeal mucosa Implantation of the removable part Four months after the first surgical intervention the cap was removed after sectioning of the pharyngea mucosa by microscissors（显微剪） endoscopically The removable part（valve system） was positioned and held in place by a clip under radioscopic control Implant follow-up Six weeks after surgery: external-beam radiotherapy（SCC classified pT4N2bM0 involving the left pyriform sinus） Retrograde nasofibroscopy of the tracheal prost