舌骨上筋群を用いた新声門再建術

Glottic reconstruction with suprahyoid muscles after total laryngectomy

　I．緒言

　喉頭全摘出後の音声リハビリテーションに関する問題は臨床的に極めて重要である。

　1970年Arslan and Serafini^1）が音声と鼻呼吸を再獲得させる手術術式を報告したが，その大胆な発想と，彼らが発表した好成績は大きな反響を呼んだ。しかし，追試者の成績は必らずしも満足すべきものではなく，1974年Staffieri^2）が鼻呼吸を放棄して誤嚥に対する変法を報告してようやく一応の評価が得られるようになった。しかしなお誤嚥を100％避けられないのが現状である。

　For the rehabilitation of voice after total laryngectomy, Serafini's operation had created a sensation in the world. However, the results of the follow-up operation were not satisfactory because of frequent occurrence of aspiration into the trachea. In this paper a modified technique of Serafini's larynoplastic operation is reported. After total laryngectomy, the trachea was separatedfrom the esophagus. The hyoid bone with the suprahyoid muscles except the mylohyoid muscle was cut in the median and the hyoid bone was sutured at the posterior margin of the trachea bilateraly. Then the mucous membrane of the hypopharynx was sutured at the margin of the trachea, and at the anterior margin, the mucous membrane of the base of the tongue or the rest of the epiglottis and the mylohyoid muscle weresutured. Thus the neoglottis was formed at the prehyoid region and suspended at the posterior margin of the neoglottis (neoarytenoid) by the suprahyoid muscles. With this method the closure of the neoglottis with the base of tongue became more complete at the swallowing. The postoperative xerograph, laryngoesophagograph and the results of phoniatrical studies are presented.