Wilson, Azure
(2024)
Preclinical investigations to optimize surgical restoration of symmetrical vocal fold vibration.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
This is the latest version of this item.
Abstract
Unilateral vocal fold paralysis presents a challenge in laryngology due to its impact on phonation caused by a gap between the vocal folds. Medialization laryngoplasty serves as the gold standard treatment for persistent unilateral vocal fold paralysis, offering long-term effectiveness and customization options. However, achieving optimal glottal closure through implant medialization laryngoplasty often relies on subjective visual-perception judgment during surgery, leading to variable outcomes. Though personalized implant shape and placement resulting in longer operative times and increased costs, contributing to inconsistency in clinical outcomes.
To address these challenges, my research introduces a preclinical approach aimed at optimizing surgical planning for medialization laryngoplasty. In the first aim, the study investigates the intrinsic biomechanical properties of the vocal folds using bioreactors and bioactive materials known as magnetic microactuators. Clinical observations support a direct link between abnormal transduction of mechanical signals and voice disorders, highlighting the importance of investigating vocal fold biomechanics. Expanding upon the established use of bioreactors to study vocal fold biology and physiology, this research incorporates a novel approach, using magnetic microactuators to allow finely adjustable frequencies for kinetic stress, aiming to glean insights into tissue responses to mechanical stimuli and explore potential interventions for enhancing vocal function.
Aim 2 addressed the need for validation of surgical and experimental methods to study medialization laryngoplasty as a treatment for vocal fold paralysis in an animal model. Surgical intervention, primarily through type I thyroplasty, aims to medialize the affected fold, but challenges such as under/over-medialization and implant variability persist, necessitating further research to enhance outcomes. Opportunities for refinement include the development of customizable implants, novel animal models simulating unilateral vocal fold paralysis, and advancements in imaging techniques.
In Aim 3, novel surgical techniques were tested to develop a reproducible method for simulating unilateral vocal fold paralysis, facilitating translation to computational models. Secondly, a custom laser-cut silicone laryngoplasty implant was developed, offering simplicity, reproducibility, and cost-effectiveness in creating personalized implants. This advancement has the potential to streamline implant customization and reduce the time and cost associated with fabrication. Furthermore, ex vivo magnetic resonance imaging of vocal folds in simulated unilateral vocal fold paralysis was utilized to inform three-dimensional finite-element models of laryngeal tissue displacement. These studies demonstrated the feasibility of estimating vocal fold vibration mode and frequency through computational models based on subject-specific laryngeal imaging.
Together, these novel surgical and computational methods establish an experimental phonation paradigm, laying the groundwork for future investigations into the surgical restoration of symmetric vibration through combined experimental and computational approaches.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
|
| Date: |
10 July 2024 |
| Date Type: |
Publication |
| Defense Date: |
9 April 2024 |
| Approval Date: |
10 July 2024 |
| Submission Date: |
3 June 2024 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
142 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Health and Rehabilitation Sciences > Communication Science and Disorders |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
voice therapy; laryngoplasty; vocal fold paralysis |
| Date Deposited: |
10 Jul 2024 15:02 |
| Last Modified: |
10 Jul 2024 15:02 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46557 |
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