Augmentation of Scarred Vocal Folds With Centrifuged and Emulsified Autologous Fat Grafts

Abstract

Objective To review the results of a series of patients with glottic insufficiency caused by scarred vocal folds who underwent injection laryngoplasty with centrifuged and emulsified autologous fat. Study Design Prospective cohort. Setting Single center, tertiary institution. Subjects and Methods Examination of the medical records of 21 patients operated on through injection laryngoplasty with fat grafts for the treatment of dysphonia was performed. All patients were operated on between January of 2015 and September of 2019. The voice variables measured were the GRABS (Grade, Roughness, Breathiness, Asthenia, Strain) scale, the Voice Handicap Index–10 (VHI-10), maximum phonation time, jitter, shimmer, and harmonic/noise ratio before surgery and 8 months later. Results Twenty-six injection laryngoplasties were performed in 21 patients during the reviewed period. Seventeen were men, and 4 were women. Mean age was 57.2 (range, 18-80) years. Mean (SD) follow-up time was 20.7 (9.3) months. Etiology of dysphonia was scarring after tumor resection in 17 patients and sulcus vocalis in 4. Five patients received an additional injection laryngoplasty. Statistically significant improvements were observed in all the parameters evaluated ( P < .05). Conclusions Injection laryngoplasty with fat grafts processed through centrifugation and emulsification is an effective technique for the treatment of dysphonia caused by glottic insufficiency related to scarred vocal folds, with minimal complication rates.

A Systematic Review on Surgical Treatments for Sulcus Vocalis and Vocal Fold Scar

“…The main characteristics of these 31 articles included in the analysis are seen in Table II Publication years of included articles ranged between 1993 and 2020. Four included studies (12.9%) were randomized controlled trials [25][26][27][28] (one of them including a placebo arm), one (3.2%) 9 was a quasi-experimental clinical trial, five (16.1%) 22,[35][36][37]41 were prospective cohorts, and the remaining (67.8%) were retrospective cohorts. Fifteen (48.4%) of the included studies had a high level of bias (MINORs score <11 points).…”

“…Three studies 14,19,21 included exclusively unilateral procedures, and five others only bilateral procedures. 20,26,27,33,34 Sixteen studies 9,16,17,20,[22][23][24][25]28,[32][33][34][35][38][39][40] (51.6%) included follow-ups greater than 6 months, and only in two studies 9,16 (6.5%) follow-up was longer than 1 year, for every patient. Of the 31 articles, 23 (74.2%) 9,13,17,21,24,25,[27][28][29][30][32][33][34][35][36]39,40 outlined self-reported outcomes, 24 (77.4%) 9,12,17,18,[21][22][23][24][25]…”

“…These studies included two different techniques: type I thyroplasty 9,31,34 and fat injection augmentation. 9,32,33,35 Self-reported outcomes had general significant improvement in most studies. A prospective study of 21 patients by Salmeron-Gonzalez et al 35 reported a significant improvement in acoustic and aerodynamic outcomes as well as perceptual and self-reported.…”

“…9,32,33,35 Self-reported outcomes had general significant improvement in most studies. A prospective study of 21 patients by Salmeron-Gonzalez et al 35 reported a significant improvement in acoustic and aerodynamic outcomes as well as perceptual and self-reported. Only one of these studies 32 analyzed stroboscopic outcomes, reporting a significant improvement in glottic gap at 3 months post-op.…”

“…Sole indirect treatments as a mainstay for sulcus and/or scar were performed in six of our reviewed studies 9,[31][32][33][34][35] (Table III). These studies included two different techniques: type I thyroplasty 9,31,34 and fat injection augmentation.…”