The human vocal folds are layered structures with intrinsically anisotropic elastic properties. Most testing methods assume isotropic behavior. Biaxial testing of vocal folds is strictly difficult because the very soft tissue tends to delaminate under transverse traction loads. In the present study, a linear transversely isotropic model was used to characterize the tissue in-vitro. Shear rheometry was used in conjunction with traction testing to quantify the elasticity of porcine vocal fold tissue. Uniaxial traction testing along with optical measurements were used to obtain the longitudinal modulus. The alternate vocal fold of each animal was subjected to a test-specific sample preparation and concurrently tested using dynamic shear rheometry. The stiffness ratio (i.e., the ratio of the longitudinal modulus and the transverse modulus) varied between ~5 and ~7 at low frequencies. The proposed methodology can be applied to other soft tissues.

Objectives Surgical adhesives are increasingly used for vocal fold microsurgery to assist wound closure and reduce the risks of scar formation. Currently used vocal fold adhesives such as fibrin glue, however, have thus far not been found to promote wound closure or reduce scarring. The objectives of this study were to investigate the mechanical strength and the cytotoxicity of three commercially available adhesives (Glubran 2, GEM, Viareggio, Italy; BioGlue, CryoLife, Kennesaw, GA; and Tisseel, Baxter Healthcare, Deerfield, IL) for vocal fold wound closure. Methods Shear and tension tests were performed on 150 porcine larynges. The cytotoxicity of the adhesives to immortalized human vocal fold fibroblasts was investigated using neutral red uptake assays. Results The average shear adhesive strength for Tisseel, BioGlue, and Glubran 2 was 13.86 ± 5.03 kilopascal (kPa), 40.92 ± 17.94 kPa, and 68.79 ± 13.29 kPa, respectively. The tensile adhesive strength for Tisseel, BioGlue, and Glubran 2 was 10.70 ± 6.42 kPa, 34.27 ± 12.59 kPa, and 46.67 ± 12.13 kPa, respectively. The vocal fold cell viabilities in extracts of Tisseel, BioGlue, and Glubran 2 were 99.27%, 43.05%, and 1.79%, respectively. Conclusion There was a clear tradeoff between adhesive strength and toxicity. The maximum failure strength in shear or tension of the three surgical adhesives ranked from strongest to the weakest was: 1) Glubran 2, 2) BioGlue, and 3) Tisseel. Tisseel was found to be the least toxic of the three adhesives, whereas Glubran 2 was the most toxic. Level of Evidence NA Laryngoscope, 129:2139–2146, 2019

A customized mechanical tester that slices thin, soft samples was utilized to measure fracture toughness of vocal fold tissue. Porcine vocal fold lamina propria was subjected to quasi-static, guillotine-like tests at three equally distanced regions along the anterior-posterior direction. The central one-third where high-velocity collisions between vocal folds occur was found to have the maximum fracture toughness. In contrast, the anterior one-third featured a lower toughness. Fracture toughness can be indicative of the risk of benign and malignant lesions in vocal fold tissue.