Long-Term Results of 18 Fat Injections in Unilateral Vocal Fold Paralysis

[en] Summary: Objective. The purposes of this study were to assess the long-term efficacy of medialization laryngo- plasty via injection of autologous fat in patients with unilateral laryngeal paralysis, and to discuss the results based on the volume of fat injected and the size of the initial glottic gap. Study design. This was a retrospective study with clinical reevaluation of 18 patients treated for unilateral laryn- geal paralysis at Liège University Hospital between April 1, 2011, and December 1, 2014. Method. The voice examination included subjective scales (GRBAS and the Voice Handicap Index), a report on acous- tic and aerodynamic voice parameters, and laryngostroboscopic assessment of glottic closure and mucosal wave (T0: preoperative; T1: immediate postoperative; T2: >1 year). Results. The median follow-up duration was 19 months. We observed a significant improvement in maximum pho- nation time; mean flow rate; jitter; the Voice Handicap Index; the G, R, B, and A subscales of the GRBAS-I; and glottic closure at T1. These parameters remained stable over time, without any significant difference except for shimmer and glottic closure between T1 and T2. Regardless of the volume of fat injected and the magnitude of the initial glottic gap, we did not see any significant difference from one assessment time to another. Conclusion. Medialization laryngoplasty by means of the injection of autologous fat is a safe, effective surgical tech- nique for patients with unilateral laryngeal paralysis regardless of the size of the initial glottic gap. The results are maintained longer than 1 year, and no evidence of significant resorption of the fat was found in our study over a period of 12–58 months. The volume of fat injected does not seem to affect the functional results. Key Words: Glottic insufficiency–Glottic closure–Glottic gap–Laryngeal paralysis–Vocal fold paralysis–Laryngoplasty– Autologous fat–Fat injection.

Disciplines :

Otolaryngology

Author, co-author :

PAGANO, Rémi ; Centre Hospitalier Universitaire de Liège - CHU > Service d'ORL, d'audiophonologie et de chir. cervico-faciale

Morsomme, Dominique ; Université de Liège > Département de Logopédie > Logopédie des troubles de la voix

CAMBY, Séverine ; Centre Hospitalier Universitaire de Liège - CHU > Service d'ORL, d'audiophonologie et de chir. cervico-faciale

Lejeune, Lionel

FINCK, Camille ; Centre Hospitalier Universitaire de Liège - CHU > Service d'ORL, d'audiophonologie et de chir. cervico-faciale

Language :

English

Title :

Long-Term Results of 18 Fat Injections in Unilateral Vocal Fold Paralysis

Publication date :

October 2016

Journal title :

Journal of Voice

ISSN :

0892-1997

eISSN :

1873-4588

Publisher :

Mosby, St Louis, United States - Missouri

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 18 January 2017

Statistics

Number of views

71 (8 by ULiège)

Number of downloads

2 (2 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

Bibliography

Flint, P.W., Downs, D.H., Coltrera, M.D., Laryngeal synkinesis following reinnervation in the rat. Neuroanatomic and physiologic study using retrograde fluorescent tracers and electromyography. Ann Otol Rhinol Laryngol 100 (1991), 797–806.
Siribodhi, C.S.W., Atkins, J.P., Bonner, F.J., Electromyographic studies of laryngeal paralysis and regeneration of laryngeal motor nerves in dogs. Laryngoscope 73 (1973), 148–164.
Tashiro, T., Experimental studies of the reinnervation of the larynx after accurate neurorrhaphy. Laryngoscope 82 (1972), 225–236.
Payr, E., Plastik am schildknorpel zur behebung der folgen einseitiger stimmbandlähmung. Dtsch Med Wochenschr 43 (1915), 1265–1267.
Guerrier, Y., Nicoleau, B., Le traitement chirurgical des paralysies recurentielles en abduction. Gazette Med 69 (1962), 3385–3388.
Isshiki, N., Tanabe, M., Sawada, M., Arytenoid adduction for unilateral vocal cord paralysis. Arch Otolaryngol 104 (1978), 555–558.
Brünings, W., Über eine neue Behandlungsmethode der Rekurrenslähmung. Verl Deutsch Laryng 18 (1911), 93–151.
Tucker, H.M., Reinnervation of the unilaterally paralyzed larynx. Ann Otol Rhinol Laryngol 86 (1977), 789–794.
Crumley, R.L., McCabe, B.F., Regeneration of the recurrent laryngeal nerve. Otolaryngol Head Neck Surg 90 (1982), 442–447.
Crumley, R.L., Update: ansa cervicalis to recurrent laryngeal nerve anastomosis for unilateral laryngeal paralysis. Laryngoscope 101 (1991), 384–387.
Marie, J.P., Remacle, M., Eckel, H.E., Surgery of Larynx and Trachea. 2010, Springer-Verlag, Berlin.
Siu, J., Tam, S., Fung, K., A comparison of outcomes in interventions for unilateral vocal fold paralysis: a systematic review. Laryngoscope 126 (2016), 1616–1624.
Mikaelian, D.O., Lowry, L.D., Sataloff, R.T., Lipoinjection for unilateral vocal cord paralysis. Laryngoscope 101 (1991), 465–468.
Brandenburg, J.H., Kirkham, W., Koschlee, D., Vocal cord augmentation with autogenous fat. Laryngoscope 102 (1992), 495–500.
Shindo, M.L., Zaretsky, L.S., Rice, D.H., Autologous fat injection for unilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 105 (1996), 602–606.
Cantarella, G., Mazzola, R.F., Domenichini, E., et al. Vocal fold augmentation by autologous fat injection with lipostructure procedure. Otolaryngol Head Neck Surg 132 (2005), 239–243.
Hsiung, M., Woo, P., Minasian, A., et al. Fat augmentation for glottic insufficiency. Laryngoscope 110 (2000), 1026–1033.
Saccogna, P.W., Werning, J.W., Setrakian, S., et al. Lipoinjection in the paralysed feline vocal fold: study of graft survival. Otolaryngol Head Neck Surg 117 (1997), 465–470.
Rima, A., De Fatta, R., De Fatta, J., et al. Laryngeal lipotransfer: review of a 14-year experience. J Voice 27 (2013), 512–515.
Dursun, G., Boynukalin, S., Ozgursoy, O.B., et al. Long-term results of different treatment modalities for glottic insufficiency. Am J Otolaryngol 29 (2008), 7–12.
Alghonaim, Y., Roskies, M., Kost, K., et al. Evaluating the timing of injection laryngoplasty for vocal fold paralysis in an attempt to avoid future type 1 thyroplasty. J Otolaryngol Head Neck Surg, 42, 2013, 24.
Yung, K.C., Likhterov, I., Courey, M.S., Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. Laryngoscope 121 (2011), 2191–2194.
Hirano, M., Clinical Examination of Voice. 1981, Springer-Verlag, Vienna.
Dejonckere, P.H., Techniques de base d'évaluation de la voix. 1985, Cabay, Louvain-la-Neuve, Belgium.
Lundy, D.S., Casiano, R.R., Xue, J.W., Thyroplasty type I: short-term versus long-term results. Otolaryngol Head Neck Surg 122 (2000), 533–536.
Morsomme, D., Estienne, F., Le bilan de la voix. 2006, Masson, Paris.
Wuyts, F.L., De Bodt, M.S., Molenberghs, G., et al. The dysphonia severity index: an objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res 43 (2000), 796–809.
Jacobson, B.H., Johnson, A., Grywalski, C., et al. The voice handicap index (VHI): development and validation. Am J Speech Lang Pathol 6 (1997), 66–70.
Powell, J., Carding, P., Birdi, R., et al. Injection laryngoplasty in the outpatient clinic under local anaesthetic: a case series of sixty-eight patients. Clin Otolaryngol 39 (2014), 224–227.
Birkent, H., Sardesai, M., Hu, A., et al. Prospective study of voice outcomes and patient tolerance of in-office percutaneous injection laryngoplasty. Laryngoscope 123 (2013), 1759–1762.
Fang, T.J., Lee, L.A., Wang, C.J., et al. Intracordal fat assessment by 3-dimensional imaging after autologous fat injection in patients with thyroidectomy induced unilateral vocal cord paralysis. Surgery 146 (2009), 82–87.
Brandenburg, J.H., Unger, J.M., Koschkee, D., Vocal cord injection with autologous fat: a long-term magnetic resonance imaging evaluation. Laryngoscope 106 (1996), 174–180.
Shaw, G.Y., Szewczyk, M.A., Searle, J., et al. Autologous fat injection into the vocal folds: technical considerations and long-term follow-up. Laryngoscope 107 (1997), 177–186.
Laccourreye, O., Papon, J.F., Kania, R., Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: long-term results from the patient's perspective. Laryngoscope 113 (2003), 541–545.
Sanderson, J.D., Simpson, C.B., Laryngeal complications after lipoinjection for vocal fold augmentation. Laryngoscope 119 (2009), 1652–1657.
Leon, X., Venegas, M.P., Orus, C., et al. Glottic immobility: retrospective study of 229 cases. Acta Otorrinolaringol Esp 52 (2001), 486–492.
Tsunoda, K., Kikkawa, Y.S., Kumada, M., et al. Hoarseness caused by unilateral vocal fold paralysis: how long should one delay phonosurgery?. Acta Otolaryngol 123 (2003), 555–556.
Umeno, H., Shirouzu, H., Chutose, S., et al. Analysis of voice function following autologous fat injection for vocal fold paralysis. Otolaryngol Head Neck Surg 132 (2005), 103–107.
Neuenschwander, M.C., Sataloff, R.T., Abaza, M.M., et al. Management of vocal fold scar with autologous fat implantation: perceptual results. J Voice 15 (2000), 295–304.
Tucker, H.M., Direct autogenous fat implantation for augmentation of the vocal folds. J Voice 15 (2001), 565–569.
McCulloch, T.M., Andrews, B.T., Hoffman, H.T., Long-term follow-up of fat injection laryngoplasty for unilateral vocal cord paralysis. Laryngoscope 112 (2002), 1235–1238.