Objective: To investigate the nature of pathological voice production and compensatory mechanism after partial laryngectomy.
Methods: Vocal function of 93 cases following partial laryngectomy (28 cases of horizontal partial laryngectomy, 35 vertical partial laryngectomy, 30 horizontal-vertical partial laryngectomy) were examined by acoustic analysis, aerodynamic analysis and videostroboscopic examination.
Results: Horizontal supraglottic laryngectomy(HL) resulted in slight dysphonia after operation. The cover of vocal fold was hypertrophic and edematous. Mucosa wave was increased. Acoustic analysis showed significant difference between normal and horizontal laryngectomy groups(P < 0.05). Vertical laryngectomy(VL) resulted in moderate-severe dysphonia. Acoustic analysis was significantly worse in VL than in normal group(P < 0.01). The nonglottic phonatory source was the contralateral ventricular fold or contralateral vestibular mucosa (arytenoid mucosa, root mucosa of glottis) to approximate the reconstructed flap. It was noted that contralateral vocal fold did not participate in vibration. Horizontal-vertical partial laryngectomy (HVL) resulted in moderate-severe dysphonia. Acoustic analysis of HVL was significantly worse than that of normal phonation(P < 0.01). The site of compensatory mucosa vibration upon phonation was the contralateral vocal fold or contralateral hypertrophic arytenoid mucosa. The thinner the flap, the better the vocal quality was. Vocal quality of VL was worse than that of HVL in regard to shimmer, jitter, normalized noise energy, maximal phonation time and harmonic-noise ratio, but there was no significant difference between them.
Conclusions: Partial laryngectomy has different vibrating compensatory modes: Voice function of horizontal partial laryngectomy was the best as it preserved the normal vibration mode; vertical partial laryngectomy was the worst with the nonglottic vibrating source of reconstructed flap-ventricular fold. The reconstructed flap, ventricular fold, mucosa of epiglottis and arytenoid take predominantly part in neoglottal vibration. The situation, volume and pliability characteristic of reconstructed flap was also important to vocal quality.