JP2009006090A - Vocal cord reinforcing tool, vocal cord atrophy preventive electrode and vocal cord atrophy preventive device including them - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a vocal cord reinforcing tool, lessening physical load on a patient due to implantation, and further easily adjusting a vocal cord function after operation. <P>SOLUTION: This vocal cord reinforcing tool 1 is formed of a balloon body 11, and the balloon body 11 has a fluid filling port 12 for injecting a fluid and a hollow part 13 for holding injected fluid. The fluid is injected from the fluid filling port 12 to the hollow part 13, thereby freely expanding and contracting the balloon body. In the interior of a vocal cord muscle layer 140 on the contracted side, the vocal cord reinforcing tool 1 is implanted in the contracted state using an endoscope, the fluid is injected into the hollow part 13 by a syringe or the like to expand the vocal cord reinforcing tool 1, thereby projecting the vocal cord 110 on the contracted side into the normal side vocal cord 110, and moving the same to open and close the glottis 120. Thus, phonation, foreign body aspiration inhibition and breath-holding can be performed. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a vocal cord reinforcement, a vocal cord atrophy prevention electrode, and a vocal cord atrophy prevention device including the same.

  The vocal cord is one of the sensory organs essential for humans to communicate with others and maintain human society. The vocal cords are located in the upper and lower two fold-like raised lower portions of the mucous membrane that rise from the left and right side walls at the center of the larynx, and are composed of a three-layer structure of muscle, connective tissue, and mucous membrane.

  However, one side of the vocal folds is injured to the median position (closed position) due to trauma, cancer surgery, aging, recurrent nerve palsy, laryngeal palsy, etc. , Causing not only voice impairment due to breath leaks and hoarseness (breathing hoarseness), but also aspiration due to dripping saliva into the trachea, as well as a decline in physical ability due to inability to hold breath, As a result, QOL (Quality of Life) in social life is significantly reduced.

  Therefore, many treatment methods for glottic insufficiency have been developed, such as fluid paraffin, Teflon (registered trademark), silicon, bovine collagen, autologous fat and fascia, solid Teflon (registered trademark) and silicon. And the like are directly injected or transplanted into the vocal cords. However, these methods have a high risk as an injection material, or require an external incision of the neck and pharynx, resulting in problems such as a large surgical invasion.

  In addition, the inventor of the present application regenerates the vocal cord mucosa for vocal cord scar lesion and vocal fold groove disease, which are typical disease models of physiological aging changes of the vocal cords, “Autologous Transplantation of Fascia” into the Vocal Fold (hereinafter referred to as “ATFV”) ”(see, for example, Non-Patent Documents 1 to 7) ATFV type 2 transplanted into the vocal cord muscle layer has been developed, and these are now the mainstream of voice surgery in the world. However, in these methods, it is very difficult to adjust the fascia volume according to the patient's physique and symptoms, the postoperative course, and the like.

  On the other hand, since the vocal cords are adjusted by moving the muscles of the vocal cords by the recurrent nerves, if the recurrent nerves are stretched, disconnected, or severed during surgery such as the thyroid gland or heart, the vocal cords are paralyzed. Causes glottic insufficiency. Furthermore, if the recurrent nerve is cut or the like, the muscle of one vocal cord is atrophied, so that the hoarseness does not improve even if the other vocal cord compensates for excessive adduction.

  Therefore, as a method for treating glottic insufficiency caused by resection of the recurrent nerve in thyroid surgery, for example, a method of transplanting cervical nerves and muscles after resection of the recurrent nerve is known (for example, Non-Patent Document 8). reference). Although this treatment method does not improve recurrent nerve palsy, it can prevent muscle atrophy by electrical stimulation by the transplanted nerve, and can improve hoarseness even if recurrent nerve palsy does not improve. Since the surgical field is the same between the thyroid surgery and the treatment method, nerve anastomosis and transplantation are possible without imposing a burden on the patient more than necessary. However, for glottic insufficiency due to unilateral recurrent nerve cuts in surgery for the esophagus, lung, follow-up, heart, etc. It is difficult to apply the method. Disruption of the recurrent nerve on both sides results in paralysis of the glottis large muscle, which causes the glottis to close and cause dyspnea contrary to glottal insufficiency. Therefore, in such a case, generally, a method of performing lifesaving by tracheotomy and then pacing the larynx has been tried. In this method, the pacing of the heart and the principle of the device are the same. For example, by applying a pulse of 1/1000 second (1 ms) with a direct current of 2 to 7 V, 30 to 40 times per second, The glottis can be opened (see, for example, Non-Patent Document 9).

However, the above-described treatment method using the pacing device is currently prohibited from use, and there is a problem in that excessive physical pain is given to the patient because the stimulation given to the muscles is large.
Tsunoda K.M. , Takanosawa M .; , Niimi S. , Laryngoscope, 1999; 109: 504-508. Tsunoda K.M. , Niimi S. , Laryngoscope, 2000; 110: 680-682. Tsunoda K.M. Baer T .; , Niimi S. , Laryngoscope, 2001; 111: 453-457. Tsunoda K.M. , Amaga N .; , Kondou K. Baer T .; , Kaga K .; , Niimi S. , Journal of Laryngol Otol, 2005; 119: 222-225. Nishiyama K. et al. , Hirose H. et al. , Horiguchi S. Tsunoda K .; , Acta Otalyarynology, 2005; 125: 1134-1135. Tsunoda K.M. , Kondou K. , Kaga K .; , Niimi S. Baer T .; , Nishiyama K .; , Hirose H. et al. , Laryngoscope, 2005 Dec. 115 (Part 2 Suppl): 1-10. Nishiyama K. et al. , Hirose H. et al. , Masaki T .; Nagai H .; Hashimoto D., et al. , Usui D., et al. Yao K .; Tsunoda K .; , Okamoto M .; , Laryngoscope, 2006 Feb .; 116 (2): 231-234. Tucker HM. , Laryngoscope, 1976; 86: 769-779. Zealear DL. , Et al, Otalyngol Head Neck Surg. , 2001 Sep. 125 (3): 183-192.

  The present invention has been made in view of such problems of the prior art, and provides a vocal cord reinforcement that can reduce physical burden on a patient due to implantation and can easily adjust the vocal cord function after surgery. The purpose is to do.

  Another object of the present invention is to provide a vocal cord reinforcement that allows a patient to freely control the vocal cord function.

  Furthermore, the present invention provides a vocal cord atrophy prevention electrode that can be directly implanted in the vocal cord and can be stimulated, and that can be driven with a low voltage and with a small number of pulses, and a vocal cord atrophy prevention device including the same. For other purposes.

  The above object of the present invention is achieved by the following means.

  (1) That is, this invention is comprised by the balloon body which can be expanded / contracted which consists of an elastic material, and is embedded and utilized in a vocal cord muscle layer, It is a vocal cord reinforcement tool characterized by the above-mentioned.

  (2) Moreover, this invention is a vocal cord reinforcement tool as described in (1) which has an injection port for inject | pouring a fluid into the inside of the said balloon body.

  (3) The present invention is also the vocal cord reinforcement according to (2), wherein the inlet has a backflow prevention valve for preventing backflow of the fluid.

  (4) Moreover, this invention has the 2nd balloon body which the inside communicated through the said balloon body and the conduit | pipe, and fluid is contained in the inside which the said balloon body, the said conduit | pipe, and the said 2nd balloon body communicated. And the second balloon body is used by being implanted under the epidermis of thyroid cartilage.

  (5) The present invention is the vocal cord reinforcement device according to any one of (1) to (4), wherein the elastic material is silicone rubber, GORE-TEX, segmented polyurethane, or soft vinyl chloride. is there.

  (6) In the present invention, the vocal cord reinforcement according to any one of (2) to (5), wherein the fluid is water, antibiotics, calcium paste, physiological saline, collagen, gelatin, or silicon. It is a tool.

  (7) Furthermore, the present invention is a vocal cord reinforcement device according to any one of (1) to (6), which is used for prevention and treatment of vocal and dysphagia due to glottic insufficiency and vocal cord atrophy. .

  (8) Further, the present invention comprises an inflatable and inflatable balloon body made of an elastic material and a pair of electrodes disposed on the surface of the balloon body. An electrode for preventing vocal cord atrophy, which is used by being connected to a pulse wave generator for generation.

  (9) Moreover, this invention is an electrode for vocal cord atrophy prevention as described in (8) which has an injection port for inject | pouring a fluid into the inside of the said balloon body.

  (10) The present invention is also the vocal cord atrophy prevention electrode according to (9), wherein the inlet has a backflow prevention valve for preventing backflow of the fluid.

  (11) The present invention provides the vocal cord atrophy prevention according to any one of (8) to (10), wherein the elastic material is silicone rubber, GORE-TEX, segmented polyurethane, or soft vinyl chloride. Electrode.

  (12) In the present invention, the fluid is water, antibiotics, calcium paste, physiological saline, collagen, gelatin, or silicon, and the vocal cord atrophy prevention according to any one of (9) to (11) Electrode.

  (13) The present invention is also the electrode for preventing vocal cord atrophy according to any one of (8) to (12), wherein the distance between the electrodes is 3 mm to 10 mm.

  (14) Further, the present invention is characterized in that the voltage applied to the electrode is 1 V to 8 V, the repetition period is 1 second to 3 seconds, and the pulse width is 1 ms to 5 ms by the pulse wave generator. , (8) to (13) any one of the electrodes for preventing vocal cord atrophy.

  (15) Further, the present invention relates to the vocal cord according to any one of (8) to (14), which is used for treatment of recurrent nerve palsy, vocal fold paralysis, trauma, inflammation, and prevention of vocal cord atrophy due to aging. This is an electrode for preventing atrophy.

  (16) Furthermore, the present invention provides a vocal cord atrophy prevention device comprising the vocal cord atrophy prevention electrode according to any one of (8) to (15) and a pulse wave generation device that generates a pulse wave. It is.

  According to the vocal cord reinforcing device of the present invention, it is possible to implant with only a slight incision using an endoscope without a large incision in the neck as in the prior art. Can be reduced.

  Furthermore, according to the vocal cord reinforcing tool of the present invention, the volume of the balloon body can be easily increased or decreased by adjusting the fluid injection amount, so that the vocal cord function can be adjusted even after the operation.

  In addition, according to the vocal cord reinforcement of the present invention, the patient himself / herself presses his / her neck to move fluid from one balloon body to the other balloon body, so that the vocal cord function can be controlled. It is possible to utter with high accuracy by inflating the vocal cord reinforcement when speaking, and it is possible to breathe easily by contracting the vocal cord reinforcement during breathing.

  Furthermore, according to the vocal cord atrophy prevention electrode and the vocal cord atrophy prevention device provided with the same according to the present invention, the electrode can be directly implanted in the vocal cord. It is possible to effectively prevent atrophy.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  FIG. 1 is a longitudinal sectional view of a vocal cord reinforcement device 1 according to the first embodiment of the present invention, and shows the configuration of the vocal cord reinforcement device 1. As shown in FIG. 1, the vocal cord reinforcement 1 includes a balloon body 11.

  The balloon body 11 has a fluid inlet 12 for injecting a fluid and a hollow portion 13 for holding the injected fluid. By injecting a fluid from the fluid inlet 12 into the hollow portion 13, It has a structure that can be expanded and contracted. The shape of the balloon body 11 is not particularly limited as long as it can be implanted inside the vocal cord muscle layer 140. For example, the shape of the balloon body 11 may be an ellipsoid, a sphere, or the like. Depending on the state of the affected area, the shape of the hollow part 13 is appropriately designed. The material of the balloon body 11 is not particularly limited as long as it has at least elasticity that can be expanded and contracted by fluid injection and strength that can hold the fluid injected therein. Can use materials excellent in biocompatibility, such as silicone rubber, GORE-TEX (registered trademark), segmented polyurethane, soft vinyl chloride, and the like.

  The fluid inlet 12 includes a backflow prevention valve 14 for preventing backflow of the injected fluid, and the backflow prevention valve 14 is punctured with a needle such as a syringe to inject fluid into the hollow portion 13. 15 is provided.

  The structure and material of the backflow prevention valve 14 are not particularly limited as long as the backflow of the fluid injected into the hollow portion 13 of the balloon body 11 is prevented, and known structures and materials can be used. However, it is particularly preferable to use a material excellent in biocompatibility, for example, silicone rubber, GORE-TEX, segmented polyurethane, soft vinyl chloride and the like.

  The fluid that can be used in the present invention is not particularly limited as long as it can be easily injected into the hollow portion 13 of the balloon body 11 with a syringe or the like and can impart elastic characteristics to the entire vocal cord reinforcement 1, but is not limited thereto. In view of the risk of leakage, it is preferable to use a highly safe substance, for example, water, antibiotics, calcium paste, physiological saline, collagen, gelatin, silicon and other liquids, and inert gases such as nitrogen gas. A gas such as a gas can be used.

  In addition, although each component of the vocal cord reinforcement tool 1 of the present invention is as described above, the vocal cord reinforcement device 1 is for embedding in the vocal cords to reinforce the vocal cords, and the vocal cord function after implantation. It must not interfere. Therefore, the vocal cord reinforcement 1 as a whole needs to have at least the strength to reinforce the vocal cords and the same degree of elasticity as the vocal cord muscles.

  Next, the usage method of the vocal cord reinforcement tool 1 according to the first embodiment of the present invention will be described based on the mechanism of voice generation by organs such as the vocal cords.

  2 is a diagram schematically illustrating the structure of the upper body of the human body, particularly the nasal cavity and throat, FIG. 3 is a longitudinal sectional view of the larynx 100, and FIG. 4 is a vocal cord 110 using a surgical laryngeal microscope. FIG. 5 is a diagram schematically showing a state in which the glottal 120 is closed when the peripheral part of the gland is observed. FIG. 5 shows the glottal 120 when the peripheral part of the vocal cord 110 is observed using a surgical laryngeal microscope. It is the figure which showed typically the state opened during utterance.

  As shown in FIGS. 2 and 3, the vocal cords 110 are located in the upper and lower two fold-like raised portions of the upper and lower left and right side walls of the larynx 100. A layered structure, that is, a structure in which an intermediate tissue composed of connective tissue called soft rhinespace is covered on the muscle, and the surface thereof is covered with a mucous membrane. The mechanism of voice generation by organs such as the vocal cords 110 is to convert the flow of air from the lungs into sound by the vocal cords 110 and utter it as a speech sound from the mouth. Exhalation as a power source is generated, and this exhalation passes through the trachea 130 and reaches the larynx 100. At the same time, the vocal cords 110 are turned inward by a command from the center, causing the glottal 120 to close at the muscle level as shown in FIG. 4, and the expiratory flow as a power source for vocalization is interrupted. Next, the Rheinkespace and the vocal cord mucosa covering the surface of the muscle with excellent flexibility are sprung upward by exhalation, and the glottis 120 is opened as shown in FIG. Gravitate. This series of movements of the vocal cords 110 is called vocal cord vibration, and it occurs 100 to 150 times for men and 200 to 300 times for women per second, and the vibration sound generated at this time is called laryngeal original sound. Voices such as vowels and consonants are added to the laryngeal original sound in the articulators such as the oral cavity, nasal cavity, tongue, palate, pharynx, and lips, and are uttered as speech sounds to generate a speech language.

  FIG. 6 is a longitudinal sectional view of the larynx 100 and schematically shows a state in which the vocal cords 110 are generally atrophied. As shown in FIG. 6, when one vocal cord 110 is generally atrophied due to aging or recurrent nerve palsy or the like, glottal 120 is incompletely closed. As a result, breathing hoarseness (breathing hoarseness) and saliva trachea Causes aspiration due to drooping into the body, and lowers physical ability due to inability to hold. Accordingly, the vocal cord reinforcement 1 according to the present invention is embedded in the vocal cord muscle layer 140 that is generally atrophied due to aging, recurrent nerve palsy, or the like and has caused the incompetence of the glottis 120 to reinforce the vocal cord. Therefore, the function can be improved.

  The vocal cord reinforcement 1 of the present invention is implanted in the vocal cord muscle layer 140 in accordance with the ATFV2 type which is a known technique (see Non-Patent Document 2).

  FIG. 7 is a transverse cross-sectional view of the larynx 100 and shows a state in which the vocal cord reinforcement 1 is embedded in the vocal cord 110. As shown in FIG. 7, the vocal cord reinforcement 1 is implanted inside the atrophyed vocal cord muscle layer 140 inside the thyroid cartilage 150.

  FIGS. 8 and 9 are longitudinal sectional views of the larynx 100. FIG. 8 shows a state before the fluid injection of the vocal cord reinforcement 1 embedded in the vocal cord 110. FIG. The state after the fluid injection | pouring of the vocal cord reinforcement tool 1 embedded inside is shown. In the ATFV type 2 described above, the fascia of the temporal muscles of the patient is collected and transplanted into the vocal cord muscle layer 140 on the atrophic side shown in FIG. "JOHNS (Journal of Ophthalmology, Head and Neck Surgery)-Otolaryngology / Head and Neck Surgery-2002; Vol. 18, No. 7, 1300-1305, refer to postoperative invasion In addition, when adjustment or the like is performed, a neck incision is necessary when transplanting again. However, when the vocal cord reinforcement 1 of the present invention is used, as shown in FIG. 8, the vocal cord reinforcement 1 is contracted under the endoscope inside the vocal cord muscle layer 140 on the atrophic side. Implanted in a state, injecting fluid from the puncture hole 15 into the hollow portion 13 with a syringe or the like, and inflating the vocal cord reinforcement 1 as shown in FIG. The vocal cord 110 can be projected into the normal vocal cord 110. As a result, the other normally functioning vocal cord 110 is moved to open and close the glottis 120 so that the vocalization can be performed.

  Therefore, if the vocal cord reinforcement tool 1 of the present invention is used, glottal insufficiency can be eliminated without performing a surgical operation with a large invasion such as an external incision, and the physical burden on the patient can be reduced. In addition, since the backflow prevention valve 14 is installed at the fluid inlet 12, there is no risk of fluid leaking into the body, and safety for the patient can be ensured. Furthermore, since a part of the fluid injection port 12 is protruded to the trachea 130 side in advance, and the volume of the balloon body 11 can be increased or decreased by using a syringe or the like after the operation, the volume of the balloon body 11 can be increased or decreased. Unlike the above, it is very easy to adjust the volume of the vocal cord reinforcement 1 after the operation.

  The vocal cord reinforcing device 1 of the present invention is completely embedded in the atrophyed vocal cord muscle layer 140 after the adjustment of the volume of the vocal cord reinforcing device 1 after the operation described above is completed and the patient's condition is stabilized. And then suture. In the present invention, only one of the left and right vocal cords 110 can be implanted. This is because the vocal cords 110 reinforced by the present invention maintain the glottal 120 closed, and the patient's respiratory path cannot be secured due to the obstruction of the trachea 130.

  FIG. 10 is a longitudinal sectional view of the vocal cord reinforcement 2 according to the second embodiment of the present invention, and shows the configuration of the vocal cord reinforcement 2. As shown in FIG. 10, the vocal cord reinforcement 2 includes a first balloon body 21 for implantation inside the vocal cord muscle layer 140, and a second balloon body 22 for implantation under the thyroid cartilage. The first balloon body 21 and the conduit 23 for communicating the inside of the second balloon body 22, the first balloon body 21, the second balloon body 22, the hollow portions 24, 25 of the conduit 23, and 26 is filled with a fluid 27. And the 1st balloon body 21 and the 2nd balloon body 22 of the vocal cord reinforcement 2 become a structure which can mutually expand / contract by moving the internal fluid 27 from one side to the other via the conduit | pipe 23. ing.

  As described above, the material of the first balloon body 21 and the second balloon body 22 has at least elasticity that can be expanded and contracted by movement of the fluid 27 and strength that can hold the fluid 27 inside. If it does, it will not specifically limit, For example, the thing similar to the balloon body 11 of the vocal cord reinforcement 1 concerning the 1st Embodiment of this invention can be utilized. Moreover, as a raw material of the conduit | pipe 23, as long as it has the intensity | strength which can move or hold | maintain the fluid 27 at least as mentioned above, it will not specifically limit.

  The fluid 27 that can be used in the present invention can move from one of the first balloon body 21 and the second balloon body 22 to the other via the conduit 23, and can impart elastic characteristics to the entire vocal cord reinforcement 2. If it is a thing, it will not specifically limit, For example, the thing similar to the vocal cord reinforcement tool 1 concerning the 1st Embodiment of this invention can be utilized.

  Next, the usage method of the vocal cord reinforcement 2 concerning the 2nd Embodiment of this invention is demonstrated. 11 is a cross-sectional view of the larynx 100, showing a state in which the vocal cord reinforcement 2 is implanted inside the vocal cord 110, and FIGS. 12 and 13 are longitudinal sectional views of the larynx 100. Fig. 13 shows a state before the fluid 27 of the vocal cord reinforcement 2 implanted in the vocal cord 110 is injected, and Fig. 13 shows a state after the fluid 27 of the vocal cord reinforcement 2 implanted in the vocal cord 110 is injected. Indicates the state.

  As shown in FIG. 11, the vocal cord reinforcement 2 of the present invention has a second balloon body 22 located outside the thyroid cartilage 150 in the vocal cord muscle layer 140 on the side where the first balloon body 21 is contracted. And the conduit 23 is placed in a state of penetrating the thyroid cartilage 150. For example, from the notch portion of the thyroid cartilage 150 after the cervical incision, only the first balloon body 21 of the vocal cord reinforcement 2 in a contracted state is confirmed with an endoscope while the vocal cord muscles on the atrophic side are contracted. The conduit 23 is placed in the state of being embedded in the layer 140 and penetrating the thyroid cartilage 150, and the second balloon body 22 in the inflated state is implanted under the outer skin of the thyroid cartilage 150.

  In FIG. 12, the second balloon body 22 in an inflated state is compressed from the outside of the larynx 100, so that the fluid 27 in the second balloon body 22 of the present invention passes through the conduit 23 and passes through the first balloon body 21. It moves to the side, and the first balloon body 21 is inflated. As a result, the contracted vocal cord 110 can be projected to the healthy vocal cord 110 (FIG. 13). As a result, the other normal vocal cord 110 is moved to open and close the glottis 120 so that the vocalization can be performed. At this time, since the volume of the first balloon body 21 can be easily adjusted according to the degree of compression of the second balloon body 22, it is possible to utter with high accuracy. Further, if the compression of the second balloon body 22 is released after the end of the utterance, the fluid 27 can move to the second balloon body 22 side through the conduit 23, and the first balloon body 21 can be deflated. Therefore, the glottis 120 can be fully opened to breathe easily (FIG. 12). In addition, due to such a feature, the vocal cord reinforcing device 2 of the present invention does not completely block the glottis 120, and therefore can be implanted in the vocal cords 110 on both the left and right sides simultaneously, and both vocal cords 110 are atrophied. It is possible to adapt to. The technique for implanting the vocal cord reinforcement 2 of the present invention is not particularly limited as long as it can be implanted as described above.

  FIG. 14 is a longitudinal sectional view of the vocal cord reinforcement device 3 according to the third embodiment of the present invention, and shows the configuration of the vocal cord reinforcement device 3. As shown in FIG. 14, the vocal cord atrophy prevention electrode 3 includes a balloon body 31 for implantation inside the vocal cord muscle layer 140, and a vocal cord muscle layer 140 provided at a substantially opposite position on the outer surface of the balloon body 31. And electrodes 32a and 32b for applying electrical stimulation by a pulse wave.

  The balloon body 31 has a fluid injection port 33 for injecting fluid and a hollow portion 34 for holding the injected fluid. The shape and material of the balloon body 31 of the vocal cord atrophy prevention electrode 3 of the present invention are not particularly limited as long as it can be implanted inside the vocal cord muscle layer 140, and the above-described first embodiment of the present invention. The same thing as the balloon body 11 of the vocal cord reinforcement 1 concerning this can be utilized.

  The fluid injection port 33 includes a backflow prevention valve 35 for preventing backflow of the injected fluid, and the backflow prevention valve 35 punctures a needle such as a syringe to inject fluid into the hollow portion 34. 36 is provided. The backflow prevention valve 35 is not particularly limited as long as the fluid does not flow back and leaks to the outside when the fluid is injected into the hollow portion 34 of the balloon body 31, and the structure and material of the backflow prevention valve 35 are not limited. As long as it prevents the backflow of the injected fluid, it is not particularly limited, and is the same as the backflow prevention valve 14 of the balloon body 11 of the vocal cord reinforcement 1 according to the first embodiment of the present invention described above. Can be used. The fluid is not particularly limited as long as it can be injected into the hollow portion 34 of the balloon body 31 and can give elastic characteristics to the entire vocal cord atrophy prevention electrode 3, and the first aspect of the present invention described above. The same thing as the vocal cord reinforcement 1 concerning embodiment of this can be utilized.

  The materials of the electrodes 32a and 32b are not particularly limited, and known materials can be used. The size and shape of the electrodes 32a and 32b are not limited, and are appropriately designed according to the state of the affected part. The distance between the electrodes 32a and 32b is determined by the size of the balloon body 31, but is preferably an interval of 3 mm to 10 mm, and particularly preferably an interval of 6 mm to 10 mm. When the interelectrode distance between the electrodes 32a and 32b exceeds the upper limit, the effect of preventing vocal cord atrophy due to electrical stimulation cannot be sufficiently obtained. When the distance between the electrodes 32a and 32b is lower than the lower limit, physical pain is caused to the patient due to excessive electrical stimulation. Both are not preferred. Furthermore, the voltage applied to the electrodes 32a and 32b is preferably 1V to 8V, particularly preferably 2V to 6V, and the repetition period is preferably 1 second to 3 seconds, particularly 1 The pulse width is preferably from 5 seconds to 2.5 seconds, and the pulse width is preferably from 1 ms to 5 ms, and particularly preferably from 2 ms to 3 ms. When the applied voltage or pulse width value of the electrodes 32a and 32b falls below the lower limit or the repetition period value exceeds the upper limit, the effect of preventing vocal cord atrophy due to electrical stimulation cannot be sufficiently obtained, and the applied voltage or pulse width If the value exceeds the upper limit or the value of the repetition period falls below the lower limit, excessive electrical stimulation will cause physical pain to the patient, which is not preferable.

  As the pulse wave generator that can be connected to the vocal cord atrophy prevention electrode 3 of the present invention, for example, a known pulse wave generator such as a tremor brain electrical stimulator (Itrel II, manufactured by Medtronic) can be used. it can. In addition, the pulse wave generator may be an “external type” attached outside the body or an “implantable type” implanted subcutaneously, and may be appropriately selected depending on the physique and age of the patient, the degree of the medical condition, the condition of the affected part, etc. Designed.

  The vocal cord atrophy prevention electrode 3 of the present invention is implanted in the vocal cord muscle layer 140 in conformity with the ATFV2 type in the same manner as the vocal cord reinforcement 1 according to the first embodiment described above. As a result, even when the recurrent nerve is stretched, disconnected, or severed in the operation of the heart or the like and the vocal cord 110 is paralyzed to cause the glottal 120 to be incompletely closed, the vocal cord atrophy prevention electrode 3 of the present invention is used. For example, the vocal cords 110 can be directly implanted by a simple technique, so that the vocal cords 110 can be stimulated with a low voltage and a small number of pulses. Further, by preventing the vocal cord 110 from atrophy, it is possible to improve the insufficiency of the glottis 120 due to over-addition by rehabilitation of the healthy vocal fold 110.

  Therefore, according to the vocal cord reinforcing device of the present invention, it is possible to implant by a simple method using an endoscope without incising the neck, so that the physical burden on the patient can be reduced, and Since the volume of the balloon body can be easily increased or decreased by adjusting the fluid injection amount, the vocal cord function can be adjusted even after the operation. Furthermore, according to the vocal cord reinforcing device of the present invention, the patient himself / herself presses his / her neck to move the fluid from one balloon body to the other balloon body, so that the vocal cord function can be controlled. It is possible to utter with high accuracy by inflating the vocal cord reinforcement when speaking, and it is possible to breathe easily by contracting the vocal cord reinforcement during breathing. Therefore, the vocal cord reinforcing device of the present invention is aging, vocal fold groove, vocal cord scar, recurrent nerve palsy, glottal insufficiency due to partial or complete removal of vocal cords due to laryngeal cancer, and vocal and swallowing disorders due to vocal cord atrophy It is extremely useful when used in the treatment of

  In addition, according to the vocal cord atrophy prevention electrode and the vocal cord atrophy prevention device provided with the same according to the present invention, the electrode can be directly implanted in the vocal cord. It is possible to effectively prevent atrophy. Therefore, the vocal cord atrophy prevention electrode and the vocal cord atrophy prevention device of the present invention are extremely useful when used for the prevention of recurrent nerve paralysis, vocal cord paralysis, trauma, inflammation, and vocal cord atrophy due to aging. .

1 is a longitudinal sectional view of a vocal cord reinforcement device 1 according to a first embodiment of the present invention, and is a view showing a configuration of a vocal cord reinforcement device 1. It is the schematic which showed typically the upper body of a human body, especially the structure of a nasal cavity and a throat. It is sectional drawing which cut | disconnected the larynx 100 to the orthogonal | vertical direction, and showed the structure typically. It is the figure which showed typically the state where the glottis 120 closed when observing the peripheral part of the vocal cord 110 using the surgical laryngeal microscope. It is the figure which showed typically the state which the glottis 120 opened during the utterance when the periphery part of the vocal cord 110 was observed using the laryngoscope for operation. It is the figure which showed typically the state where the vocal cords 110 were generally atrophied when the larynx 100 was cut | disconnected in the perpendicular direction and the cross section of the structure was observed. FIG. 3 is a cross-sectional view of the larynx 100, showing a state in which the vocal cord reinforcement 1 is embedded in the vocal cord 110. It is a longitudinal cross-sectional view of the larynx 100, and is a view showing a state in which the vocal cord reinforcement 1 before fluid injection is embedded in the vocal cord 110. It is the longitudinal cross-sectional view of the larynx 100, and is the figure which showed the state which implanted the vocal cord reinforcement 1 after the fluid injection | pouring inside the vocal cord 110. FIG. It is the longitudinal cross-sectional view of the vocal cord reinforcement tool 2 concerning the 2nd Embodiment of this invention, and is the schematic diagram which showed the structure of the vocal cord reinforcement tool 2. FIG. FIG. 2 is a transverse cross-sectional view of the larynx 100, showing a state in which the vocal cord reinforcement 2 is implanted inside the vocal cord 110. It is a longitudinal cross-sectional view of the larynx 100, and is a view showing a state in which the vocal cord reinforcement 2 before fluid injection is embedded in the vocal cord 110. It is the longitudinal cross-sectional view of the larynx 100, and is the figure which showed the state which implanted the vocal cord reinforcement 2 after the fluid injection | pouring inside the vocal cord 110. FIG. It is the longitudinal cross-sectional view of the vocal cord reinforcement tool 3 concerning the 3rd Embodiment of this invention, and is the figure which showed the structure of the vocal cord reinforcement tool 3. FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1, 2 Vocal cord reinforcement 11,31 Balloon body 12,33 Fluid injection port 13,24-26,34 Hollow part 14,35 Backflow prevention valve 15,36 Puncture hole 21 1st balloon body 22 2nd balloon body 23 Conduit 27 Fluid 3 Vocal cord atrophy prevention electrode 32a, 32b Electrode 37a, 37b Lead wire 100 Larynx 110 Vocal cord 120 Glottis 130 Trachea 140 Vocal cord muscle layer 150 Thyroid cartilage

Claims (16)

  A vocal cord reinforcement device comprising a balloon body made of an elastic material and capable of being expanded and contracted, and embedded in a vocal cord muscle layer.   The vocal cord reinforcement device according to claim 1, further comprising an inlet for injecting a fluid into the balloon body.   The vocal cord reinforcement device according to claim 2, wherein the inlet has a backflow prevention valve for preventing backflow of the fluid.   A second balloon body that communicates with the balloon body via a conduit, and the interior of the balloon body, the conduit, and the second balloon body that communicate with each other is filled with fluid; The vocal cord reinforcement device according to claim 1, wherein the body is used by being implanted under the epidermis of thyroid cartilage.   The vocal cord reinforcement according to any one of claims 1 to 4, wherein the elastic material is silicone rubber, Gore-Tex, segmented polyurethane, or soft vinyl chloride.   The vocal cord reinforcement device according to any one of claims 2 to 5, wherein the fluid is water, antibiotics, calcium paste, physiological saline, collagen, gelatin, or silicon.   The vocal cord reinforcement device according to any one of claims 1 to 6, which is used for prevention and treatment of glottal insufficiency and vocal and swallowing disorders caused by vocal cord atrophy.   An inflatable and inflatable balloon body made of an elastic material and a pair of electrodes disposed on the surface of the balloon body, and is connected to a pulse wave generator that is implanted in the vocal cord muscle layer and generates a pulse wave. An electrode for preventing vocal cord atrophy characterized by being used.   The electrode for preventing vocal cord atrophy according to claim 8, further comprising an inlet for injecting a fluid into the balloon body.   The vocal cord atrophy prevention electrode according to claim 9, wherein the injection port has a backflow prevention valve for preventing backflow of the fluid.   The vocal cord atrophy prevention electrode according to any one of claims 8 to 10, wherein the elastic material is silicone rubber, Gore-Tex, segmented polyurethane, or soft vinyl chloride.   The electrode for preventing vocal cord atrophy according to any one of claims 9 to 11, wherein the fluid is water, antibiotics, calcium paste, physiological saline, collagen, gelatin, or silicon.   The electrode for preventing vocal cord atrophy according to any one of claims 8 to 12, wherein the distance between the electrodes is 3 mm to 10 mm.   The voltage applied to the electrode by the pulse wave generator is 1 V to 8 V, the repetition period is 1 second to 3 seconds, and the pulse width is 1 ms to 5 ms. The electrode for preventing vocal cord atrophy according to item 1.   The electrode for preventing vocal cord atrophy according to any one of claims 8 to 14, which is used for treatment of recurrent nerve paralysis, vocal cord paralysis, trauma, inflammation, and vocal cord atrophy prevention due to aging.   A vocal cord atrophy prevention device comprising the vocal cord atrophy prevention electrode according to any one of claims 8 to 15 and a pulse wave generation device that generates a pulse wave.

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