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Stimmlippennarben

Pathogenese, Diagnostik, Therapie

Vocal fold scars

Pathogenesis, diagnosis, therapy

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Zusammenfassung

Stimmlippennarben beeinträchtigen die hochkomplexe Schichtstruktur der Stimmlippen und verursachen damit eine Schwingungsbehinderung und Glottisschlussinsuffizienz. Dies bedingt eine Dysphonie mit reduzierter Stimmleistungsfähigkeit. Trotz intensiver Forschung ist die Behandlung vernarbter Stimmlippen ein weitgehend ungelöstes Problem in der Laryngologie und Phonochirurgie. Entscheidend ist ein individuelles, multimodales Therapiekonzept aus chirurgischen und konservativen Maßnahmen (insbesondere Stimmtherapie). Das phonochirurgische Verfahren richtet sich primär nach der vorherrschenden Problematik: Medialisationstechniken zur Behandlung der Glottisschlussinsuffizienz bzw. Epithellösung zur Verbesserung der Schwingungsfähigkeit, häufig kombiniert mit Injektionen und/oder Implantationen. In schweren Fällen ist der Ersatz von Narbengewebe durch ein freies Mundschleimhauttransplantat eine Option. Neuere Entwicklungen sind die Behandlung mit angiolytischen Lasern [„pulse dye laser“, PDL; Kaliumtitanylphosphat(KTP)-Laser] sowie Methoden des Tissue-Engineerings. Trotz vielversprechender Ergebnisse im Tierversuch und in klinischen Pilotstudien sind dies noch keine Routineanwendungen.

Abstract

Scarring of the vocal folds leads to a deterioration of the highly complex microstructure with consecutively impaired vibratory pattern and glottic insufficiency. The resulting dysphonia is predominantly characterized by a reduced vocal capacity. Despite considerable progress in the understanding of the underlying pathophysiology, treatment of scarred vocal folds is still an unresolved chapter in laryngology and phonosurgery. Decisive for successful treatment is an individual, multidimensional concept that comprises the whole armamentarium of surgical and nonsurgical (e.g. voice therapy) modalities. The chosen phonosurgical method is determined by the main clinical feature: medialization techniques for treatment of glottic insufficiency, or epithelium-freeing techniques for improvement of vibration characteristics often combined with injection augmentation or implantation. In severe cases, buccal mucosa grafting can be an option. New developments include treatment with angiolytic lasers [pulse dye laser, PDL; potassium titanyl phosphate (KTP) laser], or techniques of tissue engineering. However, despite promising results with in vitro experiments, animal studies and first clinical trials, application in clinical routine has not yet been achieved.

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Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

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  1. Klinische Abteilung für Phoniatrie, HNO-Universitätsklinik Graz, Medizinische Universität Graz, Auenbruggerplatz 26, 8036, Graz, Österreich

    G. Friedrich & M. Gugatschka

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  1. G. Friedrich
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  2. M. Gugatschka
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Correspondence to G. Friedrich.

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Friedrich, G., Gugatschka, M. Stimmlippennarben. HNO 61, 94–101 (2013). https://doi.org/10.1007/s00106-012-2510-5

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