Phonatory Flap Wave in Platysma Skin Flap: Functional Evaluation and Influencing Factors Analysis

In this study, we analyze the phonatory function of the phonatory flap vibrational wave (PFVW) and examine potential factors influencing its formation, with a focus on the tissue structure of the platysma skin flap. This investigation aims to enhance the postsurgical voice quality of patients with laryngeal defects that have been repaired using platysma skin flaps.

A retrospective analysis was conducted on patients diagnosed with unilateral glottic laryngeal cancer, classified as T2-3N0-2M0, or those who were pathologically confirmed to have laryngeal squamous cell carcinoma, encompassing various degrees of differentiation. Following vertical partial laryngectomy, the resulting defect was repaired using platysma skin flaps. Post-surgery, the fundamental frequency (F0, Hz), jitter (%), and shimmer (%) of the patients' voices were recorded utilizing the multidimensional voice program (MDVP) system. Additionally, voice quality was evaluated subjectively using the GRBAS scale. Stroboscopic laryngoscopy was performed to observe the phonatory movements of the reconstructed larynx and the vibration of the internal flap.

Based on the presence of PFVW 3 months after surgery, 54 patients were divided into two groups: the PFVW group (20 cases) and the non-PFVW group (34 cases). After 6 months, the PFVW group exhibited significantly better jitter, shimmer, and MPT parameters than the non-PFVW group (p < 0.05). Additionally, the PFVW group had lower overall hoarseness, roughness, breathiness, strain, and total GRBAS scores than the non-PFVW group (p < 0.05). Univariate and multivariate logistic regression analyses suggested that the subcutaneous fat thickness of the platysma flap was a predictive factor for the occurrence of PFVW following vertical partial laryngectomy and platysma flap repair (odds ratio [OR] = 7.835, p = 0.003).

The thickness of subcutaneous fat tissue below the platysma muscle is an important factor affecting the occurrence of PFVW after vertical partial laryngectomy and platysma muscle reconstruction.