Long-term results of intracordal or neocordal autologous fat injection in patients with unilateral vocal cord paralysis and cordectomy

Abstract

Objectives: We investigated the long-term results of autol­ ogous fat injections for unilateral vocal cord paralysis and laryngofissure and cordectomy defects.Patients and Methods: We evaluated the efficacy of autol­ ogous fat injections in 21 patients 16 males, 5 females; mean age 57 years; range 24 to 72 years with unilateral vocal cord paralysis n=11 and cordectomy defects n=10 in the light of computed acoustic analysis, phonatory func- tions, and videolaryngostroboscopic findings and the effect of injections on swallowing. The mean follow-up was 14 months range 10 to 22 months .Results: Voice quality improved in 14 patients. Glottic insuf- ficiency recurred in three patients in the early period, and in two patients in the late period. Phonatory functions showed significant improvement in ali parameters except for jitter and functional interference p<0.05 . Videolaryngostroboscopy showed significant improvement in glottic closure, but mucosal waves remained unchanged. Of 18 patients with swallowing disorders, aspiration symptoms improved in 15 patients. Patients with unilateral vocal cord paralysis had bet- ter results compared to those with cordectomy defects.Conclusion: Autologous fat injections may be consid- ered effective in patients with cordectomy defects or uni­ lateral vocal cord paralysis.

Keywords

• Adipose tissue/transplantation, injections, intramuscular, laryngeal diseases/therapy, vocal cord paralysis, voice guality

Tek taraflı vokal kord paralizili ve kordektomili olgularda intrakordal veya neokordal otolog yağ enjeksiyonunun uzun dönem sonuçları

Abstract

Amaç: Tek taraflı vokal kord paralizilerinde ve larengofissür kordektomi defektlerinde otolog yağ enjeksiyonununuzun dönem etkinliği araştırıldı.Hastalar ve Yöntemler: Tek taraflı vokal kord paralizili n=11 ve kordektomi skar dokulu n=10 toplam 21 hastaya otolog yağ enjeksiyonu uygulandı. Fonatuar fonksiyonlar,bilgisayarlı akustik analizler ve videolarengostroboskopikbulguların yanı sıra otolog yağ enjeksiyonunun yutmabozukluğu üzerine etkinliği değerlendirildi. Ortalama izlem süresi 14 ay dağılım 10-22 ay idi.Bulgular: On dört hastada ses kalitesi ameliyat öncesinegöre daha iyi idi. Üç hastada erken dönem, ikisinde geçdönemde glottik yetersizlik semptomları tekrarladı. Fonatuar fonksiyonlarda jitter ve efor dışında tüm parametrelerde anlamlı düzelme vardı p

Keywords

• Yağ dokusu/transplantasyon, enjeksiyon,intramusküler, larenks hastalıkları/tedavi, vokal cord paralizisi, ses kalitesi

References

1. Kasperbauer JL, Slavit DH, Maragos NE. Teflon gran- ulomas and overinjection of Teflon: a therapeutic chal- lenge for the otorhinolaryngologist. Ann Otol Rhinol Laryngol 1993;102:748-51.
2. Ford CN, Bless DM, Loftus JM. Role of injectable col- lagen in the treatment of glottic insufficiency: a study of 119 patients. Ann Otol Rhinol Laryngol 1992;101:237-47.
3. Mikaelian DO, Lowry LD, Sataloff RT. Lipoinjection for unilateral vocal cord paralysis. Laryngoscope 1991;101:465-8.
4. Shindo ML, Zaretsky LS, Rice DH. Autologous fat injection for unilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 1996;105:602-6.
5. Shaw GY, Szewczyk MA, Searle J, Woodroof J. Autologous fat injection into the vocal folds: technical considerations and long-term follow-up. Laryngoscope 1997;107:177-86.
6. Güven M. İntrakordal veya neokordal yağ enjeksiyo- nu: Kordektomili ve rekürren larengeal sinir paralizili hastalarda akustik ve fonatuar analiz ile değerlendir- me [Uzmanlık Tezi]. İstanbul: İ. Ü. İstanbul Tıp Fakül- tesi; 2001.
7. Bless DM, Hirano M, Feder RJ. Videostroboscopic evaluation of the larynx. Ear Nose Throat J 1987;66:289-96.
8. Pearson BW. Subtotal laryngectomy. Laryngoscope 1981;91:1904-12.

9. Logemann JA. Swallowing physiology and patho- physiology. Otolaryngol Clin North Am 1988;21:613- 23.
10. Brandenburg JH, Kirkham W, Koschkee D. Vocal cord augmentation with autogenous fat. Laryngoscope 1992;102:495-500.
11. Brandenburg JH, Unger JM, Koschkee D. Vocal cord injection with autogenous fat: a long-term magnetic resonance imaging evaluation. Laryngoscope 1996;106(2 Pt 1):174-80.
12. Sittel C, Friedrich G, Zorowka P, Eckel HE. Surgical voice rehabilitation after laser surgery for glottic carci- noma. Ann Otol Rhinol Laryngol 2002;111:493-9.
13. Isshiki N. Mechanical and dynamic aspects of voice production as related to voice therapy and phono- surgery. J Voice 1998;12:125-37.
14. Eckel HE, Thumfart W, Jungehulsing M, Sittel C, Stennert E. Transoral laser surgery for early glottic car- cinoma. Eur Arch Otorhinolaryngol 2000;257:221-6.
15. Pech A, Thomassin JM, Goubert JL, Zanaret M, Scavennec C, Cannoni M. Glottic reconstruction with a flap of thyroid perichondrium. Ann Otolaryngol Chir Cervicofac 1984;101:319-22. [Abstract]
16. Hsiung MW, Woo P, Minasian A, Schaefer Mojica J. Fat augmentation for glottic insufficiency. Laryngoscope 2000;110:1026-33.
17. Hill DP, Meyers AD, Harris J. Autologous fat injection for vocal cord medialization in the canine larynx. Laryngoscope 1991;101(4 Pt 1):344-8.
18. Zaretsky LS, Shindo ML, deTar M, Rice DH. Autologous fat injection for vocal fold paralysis: long- term histologic evaluation. Ann Otol Rhinol Laryngol 1995;104:1-4.
19. Saccogna PW, Werning JW, Setrakian S, Strauss M. Lipoinjection in the paralyzed feline vocal fold: study of graft survival. Otolaryngol Head Neck Surg 1997;117:465-70.
20. Bauer CA, Valentino J, Hoffman HT. Long-term result of vocal cord augmentation with autogenous fat. Ann Otol Rhinol Laryngol 1995;104:871-4.
21. Mikus JL, Koufman JA, Kilpatrick SE. Fate of liposuc- tioned and purified autologous fat injections in the canine vocal fold. Laryngoscope 1995;105:17-22.
22. Boyce RG, Nuss DW, Kluka EA. The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck. Otolaryngol Clin North Am 1994;27:39-68.
23. Laccourreye O, Paczona R, Ageel M, Hans S, Brasnu D, Crevier-Buchman L. Intracordal autologous fat injection for aspiration after recurrent laryngeal nerve paralysis. Eur Arch Otorhinolaryngol 1999;256:458- 61.
24. Rihkanen H, Lehikoinen-Soderlund S, Reijonen P. Voice acoustics after autologous fascia injection for vocal fold paralysis. Laryngoscope 1999;109:1854-8.
25. Laccourreye O, Papon JF, Kania R, Crevier-Buchman L, Brasnu D, Hans S. Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paraly- sis: long-term results from the patient’s perspective. Laryngoscope 2003;113:541-5.