PubMed · 6041515
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J H Ogura, F Barnhill. 1967. Partial laryngectomy.. https://pubmed.ncbi.nlm.nih.gov/6041515/
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PURPOSE: The tracheostomy stoma is a potential site of recurrence for patients who have subglottic cancer or subglottic spread of cancer. In these patients, it is important that the anterior supraclavicular field does not underdose the posterior wall of the tracheostomy stoma when using a 6-MV anterior photon field. Conventionally, this problem is surmounted with placement of a plastic tracheostomy tube, which is uncomfortable for the patient, potentially traumatic, and can interfere with vocalization via a tracheal esophageal puncture. Our study was designed to investigate the dosimetry of this region and see if alternate methods would be effective. METHODS AND MATERIALS: A phantom was constructed using a No. 6 tracheostomy tube as the model for the tracheostomy curvature and size. Using the water-equivalent phantom, film dosimetry, and films oriented parallel to the en face field, we investigated the dose at the depth of the surface of the posterior wall of the phantom's tracheostomy stoma. Dose was measured both in space and at the tissue interface by scanning points of interest both horizontally and vertically. We measured doses with a No. 6 and No. 8 plastic tracheostomy tube, either 0.5 cm and 1.0 cm of bolus (1-cm airhole) with no tracheostomy tube, as well as 0.3 cm and 0.6 cm tissue-equivalent Aquaplast (Med-Tec Co., Orange City, Iowa) over the tracheostomy. Dosimetry at the posterior interface was confirmed using thermoluminescent dosimeters. RESULTS: Three mm and 6 mm of Aquaplast produced a posterior tracheal dose of 93% and 100%. CONCLUSION: There is no need for these patients to wear a temporary plastic tracheostomy tube during their external radiation therapy. Aquaplast should allow better position reproducibility, reduce trauma, not interfere with patient respiratory efforts, and be compatible with vocalization via a tracheal esophageal puncture.
Human phonation does not always involve symmetric motions of the two vocal folds. Asymmetric motions can create slanted or oblique glottal angles. This study reports intraglottal pressure profiles for a Plexiglas model of the larynx with a glottis having a 10-degree divergence angle and either a symmetric orientation or an oblique angle of 15 degrees. For the oblique glottis, one side was divergent and the other convergent. The vocal fold surfaces had 14 pressure taps. The minimal glottal diameter was held constant at 0.04 cm. Results indicated that for either the symmetric or oblique case, the pressure profiles were different on the two sides of the glottis except for the symmetric geometry for a transglottal pressure of 3 cm H2O. For the symmetric case, flow separation created lower pressures on the side where the flow stayed attached to the wall, and the largest pressure differences between the two sides of the channel were 5%-6% of the transglottal pressure. For the oblique case, pressures were lower on the divergent glottal side near the glottal entry and exit, and the cross-channel pressures at the glottis entrance differed by 27% of the transglottal pressure. The empirical pressure distributions were supported by computational results. The observed aerodynamic asymmetries could be a factor contributing to normal jitter values and differences in vocal fold phasing.
This study presents stochastic models of jitter. Jitter designates small, random, involuntary perturbations of the glottal cycle lengths. Jitter is a base-line phenomenon that may be observed in all voiced speech sounds. Knowledge of its properties is therefore relevant to the acoustic modeling, analysis, and synthesis of voice quality. Also, models of jitter are conceptual frameworks that enable experimenters and clinicians to distinguish jitter in particular from aperiodic cycle length patterns in general. Vocal jitter is modeled by means of the ribbon model of the glottal vibration combined with stochastic models of the disturbances of the instantaneous frequency. The disturbance model comprises correlation-free noise and vocal microtremor. Properties of jitter that are simulated are the stochasticity, stationarity, and normality of the decorrelated cycle length perturbations, the size of decorrelated jitter, the correlation between the perturbations of neighboring glottal cycles, the modulation level and modulation frequency owing to microtremor, the asynchrony between external disturbances and glottal cycles, the dependence of the size of jitter on the average glottal cycle length, and the relation between jitter and laryngeal pathologies. Modeled jitter is discussed in the light of measured jitter, as well as the physiological and statistical plausibility of the model parameters.