| Project/Area Number |
11835044
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Institution | Nihon University |
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Principal Investigator |
MAKIYAMA Kiyoshi Nihon University, School of Medicine, Assistant professor, 医学部, 講師 (00139172)
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| Co-Investigator(Kenkyū-buntansha) |
KIDA Akinori Nihon University, School of Medicine, Professor, 医学部, 教授 (00096801)
NOZAKI Motohiro Tokyo Women's Medical University, School of Medicine, Professor, 医学部, 教授 (70086586)
NIIMI Seiji University of Tokyo, Graduate School of Medicine, Professor, 大学院・医学研究科, 教授 (00010273)
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| Project Period (FY) |
1999 – 2000
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| Project Status |
Completed (Fiscal Year 2000)
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| Budget Amount *help |
¥3,400,000 (Direct Cost: ¥3,400,000)
Fiscal Year 2000: ¥800,000 (Direct Cost: ¥800,000)
Fiscal Year 1999: ¥2,600,000 (Direct Cost: ¥2,600,000)
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| Keywords | Laryngectomized patients / Voice reconstruction / Neoglottis / Phonatory function / High-speed digital imaging / T-E shunt / Esophageal speech / Expiratory lung pressure |
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| Research Abstract |
This study was conducted to investigate the neoglottis and phonatory function after elephant type voice reconstruction using a free jejunal autograft in comparison with the patients of esophageal speech or T-E shunt. The neoglottic vibration was investigated using high-speed digital image recording System. Expiratory lung pressure during phonation was determined simultaneously with the fundamental frequency, sound pressure level, and mean flow rate (MFR), using the phonatory function analyzer NAGASHIMA PS77E.
The first group underwent total laryngectomy. The hypopharyngeal mucosa above the esophageal entrance plays the role of the neoglottis of the esophageal speech. The mucosal surface of the neoglottis protrudes like a valve and vibrates. In the patient with a T-E shunt, the neoglottis is closed and vibrates during phonation.
The second group underwent laryngopharyngoesophagectomy with a free jejunal graft : elephant type shunt. Mucosal vibration is seen in the lumen of the jejunum. In contrast to esophageal speech, the neoglottis remains open during phonation. We consider that when the expiratory air passes through the shunt to the jejunal lumen, the local mucosa is sucked by the Bernoulli effect to serve as a sound source.
In the first group, both expiratory lung pressure and MFR were in low or normal level. In the elephant type voice reconstruction group, the pressure and MFR were in high level. The airway resistance, which is the expiratory lung pressure per MFR quotient, was high in the elephant group. Because the lumen of the voice reconstruction site is narrow and possesses mucosal folds, airway resistance should be high during expiration. In other words, a high expiratory lung pressure is required due to an airway stenosis between the trachea and neoglottis in the elephant group.
Based on the present results, we wish to improve surgical techniques and training methods for better voice restoration.
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