title: [Objective assessment of combined soft tissue flap in defect repair of laryngeal carcinoma operation].
abstract: OBJECTIVE
  To objectively evaluate the effectiveness of the ventricular fold pull-down combined with strip myofascial flap to repair laryngeal defect after early glottic carcinoma operation with glottic morphological parameters and voice parameters.
  
  
  METHODS
  Between January 2008 and December 2012, 47 patients with early glottic carcinoma and anterior commissure involvement underwent partial laryngectomy. All patients were male, aged from 60 to 75 years (mean, 68.5 years). The disease duration was 4-11 months (mean, 7.2 months). According to American Joint Committee on Cancer (AJCC) TNM criteria, 28 cases were classified as T1aN0M0, 14 cases as T1bN0M0, and 5 cases as T2NoMo. Laryngeal defect after resection of tumor was repaired by ventricular fold pull-down combined with strip myofascial flap. At 1 day before operation and at 1 year after operation, multilayer spiral CT was used to scan larynx, to measure and compare the anteroposterior diameter of vocal area, the distance between both sides of the vocal process, and the thickness of soft tissue of vocal area, and the effect of combined soft tissue flap was objectively assessed in laryngeal morphology reconstruction. The actual voice parameters [including Fo, Jitter, Shimmer, normalized noise energy (NNE), and maximum phonatory time (MPT)] were tested and compared, and the effect of the combined soft tissue flap on postoperative laryngeal pronunciation was evaluated.
  
  
  RESULTS
  Postoperative pathological examination revealed well-differentiated squamous cell carcinoma in 38 cases, and moderately-differentiated squamous cell carcinoma in 9 cases; no tumor was found in the resection margin. Healing of neck incision was obtained in all patients at 7-9 days after operation. Forty-four cases were decannulated at 9-11 days after operation and the remaining 3 cases were decannulated at 3 weeks after operation. Oral feeding usually started in all cases at 3-4 days after operation. All patients were followed up 1 year. At 1 year after operation, the anteroposterior diameter of vocal area was significantly reduced when compared with preoperative one (t = 15.161, P = 0.000); the distance between both sides of the vocal process and the thickness of soft tissue of vocal area had no significant changes (P > 0.05). Compared with preoperative ones, there were significant differences in Shimmer, NNE, and MPT (P < 0.05), but no significant difference was found in Fo and Jitter (P > 0.05) at 1 year after operation.
  
  
  CONCLUSIONS
  Ventricular fold pull-down combined with strip myofascial flap can repair laryngeal defect effectively after partial laryngectomy and maintain the effective airway after operation. It not only has no effect on postoperative laryngeal morphology, but also can be used as new laryngeal voice vibration body.
authors.forename: Fenglin
authors.initials: F
authors.lastname: Sun
authors.forename: Haiyang
authors.initials: H
authors.lastname: Yu
authors.forename: Huijuan
authors.initials: H
authors.lastname: Xu
authors.forename: Rong
authors.initials: R
authors.lastname: Xu
authors.forename: Haipeng
authors.initials: H
authors.lastname: Wang
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Xia
authors.forename: Huizhong
authors.initials: H
authors.lastname: Wang
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005931:Glottis; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D007831:Larynx, Artificial; D008297:Male; D011184:Postoperative Period; D013524:Surgical Flaps; D016896:Treatment Outcome