Evaluation Of Voice And Swallowing Function Of Montgomery Prosthesis Implantation In The Treatment Of Unilateral Vocal Fold Paralysis

[Objective]The postoperative effects of 23 patients with unilateral vocal fold paralysis who underwent type Ⅰ thyroplasty and Montgomery implant internal transfer of vocal fold in our hospital were analyzed retrospectively to explore the voice improvement of unilateral vocal fold paralysis patients treated with Montgomery implant internal transfer of vocal fold and to analyze the significance of the operation in improving swallowing dysfunction.[Methods]The clinical data of 23 patients with unilateral vocal fold paralysis who underwent Montgomery prosthesis implantation in the Department of Otorhinolaryngology and head and neck surgery in our hospital from April 2015 to January 2021 were analyzed retrospectively,including 16 males and 7 females,aged 25-72 years.The evaluation methods include GRBAS auditory perception assessment,subjective aspiration assessment and 8-point Penetration-Aspiration Scale（PAS）;voice acoustic parameter evaluation[including average fundamental frequency（F0）,jitter percent（Jitt%）,shimmer percent（Shimmer）,noise-to-harmonic ratio（NHR）,soft phonation index（SPI）,voice turbulence index（VTI）].maximum phonation time（MPT）;fiberoptic laryngoscope was used to evaluate the opening of glottis and the position of vocal cords.The acoustic parameters and MPT data were statistically analyzed by paired t-test,and the GRBAS data and aspiration subjective evaluation were analyzed by rank sum test.The voice and swallowing function of the patients were evaluated,and the differences before and after operation were analyzed.[Results]A total of 23 patients were included in this study,with an average age of 50.48±13.95 years.In the evaluation of voice function,the GRBAS auditory perception evaluation found that the values of M[P₂₅and P₇₅]before and after operation were all P<0.05,which was statistically significant.Among the objective acoustic indexes of voice,jitter percent（Jitt%）,shimmer percent（shim）,the harmonic-to-noise ratio（NHR）and the maximum phonation time（MPT）were P<0.01,and the differences were statistically significant.The average fundamental frequency（F0）,soft phonation index（SPI）and voice turbulence index（VTI）were all P>0.05,and the difference was not statistically significant.The grade of aspiration in 16 patients with dysphagia was compared before and after operation,the difference was statistically significant（P=0.001<0.01）.The glottic closure and the position of vocal cords on the affected side were evaluated by laryngoscope before and after operation,P<0.01,and the difference was statistically significant.[Conclusion]Type Ⅰ thyroplasty-Montgomery implant transposition of vocal folds can effectively improve the voice of patients with unilateral vocal fold paralysis,increase the airway protection of unilateral vocal fold paralysis patients with dysphagia such as drinking water and eating cough,improve the safety and effectiveness of swallowing,create conditions for the development of swallowing rehabilitation training,and better meet the bio-psycho-social needs of patients.