Auto‐Crosslinked Hyaluronan Gel Injections in Phonosurgery

Abstract

Adult idiopathic subglottic stenosis remains a rare entity. Fibrosis of the airway at the level of the cricoid results in narrowing of the airway and progressive dyspnoea. The aetiology remains uncertain but reflux and hormonal influences have recently been proposed. Multiple modalities including surgical excision, laser excision and balloon dilatation have been described. Additionally the adjunctive use of mitomycin or oestrogen has also been noted. From these options, cricotracheal resection and reconstruction for severe stenosis remains the modality providing the most favourable results. METHODS: We present our use of balloon dilatation in two cases as a management option with concomitant subglottic high frequency jet ventilation. Initially used in angioplasty, balloon dilatation has subsequently been successfully used for oesophageal dilatation and airway disorders. Control of ventilation during dilatation may be by endotracheal tube insertion and periodic removal, by supra-glottic jet ventilation, or our preferred modality of automated subglottic high frequency jet ventilation (Mistral model, Acutronic, Switzerland). RESULTS: The latter provides a clear visualisation of the stenotic region allowing sequential photodocumentation preand post-treatment with the additional ease of withdrawing and re-introduction of the catheter before and after dilation. The use of a hydrostatic balloon catheter (Cook Medical, USA) provides an optimal compliance curve that conforms to the stenotic region allowing radial dilation. CONCLUSIONS: Although this technique may not have the long-term efficacy of open surgical methods, it provides a non-invasive and relatively easily learned technique to manage this difficult condition.

Outcomes versus complications in patients undergoing different modalities of injection laryngoplasty

“…The best postoperative voice outcomes were noted in patients with UVFP, which was consistent with literature reports of Friedman et al [22] and Reiter and Brosch [23]. Also, the best results were obtained in cases with small to moderate phonatory gap, as consistent with King and Simpson [24] and Molteni et al [25].…”

Vocal fold medialization—A 5‐year series of single surgeon consecutive medialization with review of literature

“…Hyaluronic acid gels are animal‐ or bacterial‐derived variations of the naturally occurring extracellular matrix glycosaminoglycan found in human tissue. These have been shown to be both safe and effective for deep injection, with the substance lasting from 4 to 12 months …”

Prospective multi‐arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis

“…We focused on three singular treatment modalities in this study, primarily due to their prominence and reported value in the clinical literature. Consequently, it is unknown how type I thyroplasty, injection laryngoplasty, and graft implantation outcomes compare to other proposed approaches such as mucosal slicing, 24 pulsed dye laser irradiation, 38 steroid injection, 35 and superficial injection/implantation of hyaluronic acid‐based biomaterials 36, 37 or autologous fat. 27, 28, 33, 34 Further, we did not include combinative treatments, such as CO 2 laser excision followed by collagen injection, 19, 20 fascia implantation followed by fat injection, 32 or gelatin sponge implantation followed by fat injection; 26 each of which holds the conceptual appeal of simultaneously or sequentially tackling glottal incompetence and lamina propria issues, with possibly compounded benefit.…”

“…13 The classic medialization approaches of type I thyroplasty and injection laryngoplasty are familiar to most surgeons and generally considered robust. 14–18 Approaches to treatment of the lamina propria are more challenging and include scar/sulcus excision, 19–21 undermining and release, 22, 23 mucosal slicing, 24 superficial implantation of autologous fat, fascia, or other scaffold materials, 25–34 superficial injection of steroids or regenerative biomaterials, 35–37 and pulsed dye laser irradiation. 38…”