Frequent allelic loss at chromosome 3p distinct from genetic alterations of the 8-oxoguanine DNA glycosylase 1 gene in head and neck cancer

Cigarette smoking is the major known risk factor for head and neck cancer. Tobacco promotes oxidative stress and enhances tissue levels of 8-hydroxyguanine (8-OH-G) in smokers. The presence of 8-OH-G does not impede replication but leads to an accumulation of G-->T transversions. Recently, the gene for human 8-oxoguanine DNA glycosylase 1 (hOGG1), an enzyme involved in the repair of 8-OH-G in humans, was cloned and mapped to chromosome 3p. In head and neck tumors, the hOGG1 gene locus is often targeted by loss of heterozygosity (LOH), and the spectrum of mutations in the p53 gene shows a bias in favor of G:C-->T:A transversions, as would be expected if HOGG1 repair functions were disabled. To test the involvement of hOGG1 in head and neck carcinogenesis, we had previously screened 56 tumors for LOH at 3p. From these tumors and two others, we selected 33 tumors demonstrating LOH for further mutational analysis of this gene. No somatic inactivating mutation was found in hOGG1. Polymorphisms involving intron 4 and exon 7 were present in 30% of the patients. A new polymorphism was identified in one patient in exon 6 and led to the amino-acid change G308E. Similar repair activities were found for the wild-type and exon 6-variant enzymes. Therefore, the involvement of hOGG1 in head and neck carcinogenesis is not strongly supported by this work.

Intracordal autologous fat injection for aspiration after recurrent laryngeal nerve paralysis

The present prospective study was designed to analyze the results achieved with intracordal autologous fat injection for aspiration in a series of 20 patients with recurrent laryngeal nerve paralysis. Swallowing was documented by having each patient swallow puréed food colored with methylene blue during nasofibroscopy. No laryngeal adverse effects were associated with the intracordal injection of fat. One patient developed an abdominal hematoma at the donor site. The intracordal injection of autologous fat after 1 year resulted in an 85% successful rehabilitation of swallowing. One of the three patients who failed the initial rehabilitation of swallowing was managed successfully with reinjection of autologous fat, resulting in a 90% definitive successful rehabilitation of swallowing. In all patients, speech and voice were immediately improved after the intracordal injection of autologous fat. Objective acoustic recordings documented the improvement in selected speech and voice parameters when compared with pretreatment data. Our presented experience shows that the intracordal autologous fat injection is a safe and valuable treatment option in patients with aspiration after recurrent laryngeal nerve paralysis.

Subcranial fronto-orbito-nasal approach for ethmoidal cancers surgical techniques and results

BACKGROUND

The authors report their experience with the subfronto-orbito-nasal approach (SFON) for the treatment of 30 patients suffering from ethmoidal cancers over the past 3 years. The advantages and pitfalls of this technique are described and compared with other classic approaches.

METHODS

Among 156 patients suffering from ethmoidal cancers and treated between January 1984 and January 1998, 30 patients were operated on using the SFON approach during the past 3 years. There were 27 males and 3 females, ranging in age from 15 to 77 years. Histologic composition of the lesions was as follows: 15 adenocarcinomas, 6 esthesioneuroblastomas, 3 melanomas, 2 epidermoid carcinomas, 1 nondifferentiated carcinoma, 1 neuroendocrine carcinoma, 1 villous carcinoma, and 1 cystic adenoid carcinoma (cylindroma). According to the authors' classification, 7% were T1, 6% T2, 22% T3, 38.5% T4a, and 26.5% T4b. All patients were operated on through a SFON approach, followed by removal of the tumor and reconstruction of the skull base with a pericranial flap.

RESULTS

Since the mean follow-up was of short duration (12 months, ranging from 3 to 29 months), significant carcinologic results could not be obtained. However, a detailed analysis of the surgical procedure was performed. No patient died or had major complications related to the SFON approach. One cerebrospinal fluid (CSF) fistula and four oculomotricity dysfunctions were observed. Definitive anosmia was reported in all cases.

CONCLUSION

The advantages of the procedure include a wide exposure of the anterior skull base through a limited approach, the possibility of modifying the approach according to the size and location of the lesion, total resection of tumors, simplified skull base reconstruction technique, and reduction of postoperative confusion and hospital stay.

[Idiopathic sub-glottal stenosis in the adult]

Idiopathic subglottic stenosis is a rare condition. The records of five patients with idiopathic subglottic stenosis treated between 1989 and 1998 were reviewed. All were female and had similar clinical and histopathologic features. Endoscopic dilatation or/and radial CO2 laser and dilatation were successful in maintaining the airway of all five patients without tracheotomy. The pathogenesis of idiopathic subglottic stenosis is strictly speculative, for this reason we advocate a conservative approach.

Long-term results after esophagectomy for squamous cell carcinoma of the esophagus associated with head and neck cancer

BACKGROUND

Esophageal squamous cell carcinomas are frequently associated with head and neck cancers. The poor prognosis of each cancer, and their proximity, often limit the treatment options. This study was conducted to determine the characteristics and long-term outcome of such dual cancers.

PATIENTS AND METHODS

We included 75 patients with esophageal carcinoma, of whom 25 had a synchronous head and neck malignancy. Curative treatment was possible in every case. The patients were divided into "solitary cancer" and "synchronous cancer" groups.

RESULTS

The gender distribution, tumor location, and histological findings were similar in the two groups. Patients in the synchronous cancer group were younger than those in the solitary group (P < 0.0042). The operative mortality and pulmonary morbidity rates were not significantly different in the two groups. The rate of cervical anastomotic leaks was higher in the synchronous group (P < 0.05). The mean follow-up was 83 +/- 50 months. Five-year survival rates were not significantly different in the two groups (14.3% +/- 5.7% in the solitary group and 17.5% +/- 7.9% in the synchronous group).

CONCLUSIONS

With aggressive treatment, the survival of patients with synchronous esophageal and head and neck cancers was similar to that of patients with isolated esophageal cancer.

Microsatellite analysis and response to chemotherapy in head-and-neck squamous-cell carcinoma

Molecular studies have revealed that microsatellite instability and loss of heterozygosity occurred in head-and-neck cancer, suggesting the involvement both of suppressor and of mutator pathways in head-and-neck carcinogenesis. There is evidence for relations between tumor phenotype and clinical parameters. Indeed, replication-error phenotype, characterized by microsatellite instability, was associated with decreased sensitivity to chemotherapeutic agents in cell lines. Loss of heterozygosity is a frequent mechanism of inactivation of tumor-suppressor genes, which might be implicated in resistance to chemotherapy. In head-and-neck cancer, chemosensitivity is inconstant, and no marker is available to predict response to treatment. In order to evaluate the role of tumor phenotype on resistance to chemotherapy, we analyzed 56 primary head-and-neck squamous-cell carcinomas collected at time of diagnosis and a sub-group of 23 resistant tumors collected after chemotherapy at 22 microsatellite loci. At time of diagnosis, only one tumor showed MSI-H phenotype. Loss of heterozygosity (LOH) was observed in 75% of tumors, indicating the dominant role of the suppressor in comparison with the mutator pathway in HNSCC carcinogenesis. No change in microsatellite patterns was observed after treatment, suggesting that chemotherapy did not select mismatch-repair-deficient clones. Univariate analyses showed that LOH at 9p or 17p was significantly associated with drug resistance. In a multivariate analysis, only LOH at 17p remains predictive of low response to chemotherapy, with a relative risk of 3.7 and 95% CI of 1.1-13, indicating that p53 alterations could play a role in chemotherapy resistance in HNSCC. Int. J. Cancer (Pred. Oncol.) 84:410-415, 1999.

Local recurrence after vertical partial laryngectomy, a conservative modality of treatment for patients with Stage I-II squamous cell carcinoma of the glottis

BACKGROUND

Based on an inception cohort of 103 patients who had local recurrence (Group I) and a witness group of 311 patients who achieved local control (Group II) after vertical partial laryngectomy for Stage I-II glottic carcinoma, the current retrospective study documented the consequences and management of local recurrence.

METHODS

Three hundred two patients (97.1%) in Group II and all 103 patients (100%) in Group I were followed until death or for a minimum of 10 years. Statistical analysis of survival, lymph node control, and distant metastasis was based on the Kaplan-Meier product limit method.

RESULTS

The 10-year actuarial survival estimate was 30.8% for Group I patients and 63.1% for Group II patients. Survival was statistically more likely to be reduced in Group I patients (P < 0.0001) than in Group II patients. The percentage of patients who died of their initial disease was 44.6% in Group I and 6.3% in Group II. The 10-year actuarial lymph node control estimate was 70.2% for Group I and 96.1% for Group II. Lymph node recurrence was statistically more likely to occur in Group I patients than in Group II patients (P < 0.0001). The 10-year actuarial estimate for patients without distant metastasis was 80.2% for Group I and 96.7% for Group II. Distant metastasis was statistically more likely to occur in Group I patients than in Group II patients (P < 0.0001). Salvage treatment was unsuitable for 4.7% of patients with local recurrence; for other patients, it yielded a 86.7% local control rate, a 21.4% laryngeal preservation rate, a 4.5% death rate, and an 11.2% rate of incidence of severe complications.

CONCLUSIONS

Among patients with Stage I-II glottic carcinoma managed with vertical partial laryngectomy, local recurrence results in a reduced rate of survival as well as a high rate of necessity for salvage total laryngectomy.

[Severe Frey syndrome after parotidectomy: treatment with botulinum neurotoxin type A]

Based upon an inception cohort of 30 patients with severe Frey's syndrome, after conservative parotidectomy, the technique and the results of intracutaneous injection of botulinum toxin type A are presented. The skin surface involved with Frey's syndrome was managed with intracutaneous injection of 2.5 international units of botulinum toxin type A per square centimeter. A minimum follow-up of 16 months was achieved. The only adverse side effect encountered was a temporary paresis of the upper lid noted in 2 patients. Frey's syndrome vanished within 2-5 days from the intracutaneous injection of botulinum toxin type A. Frey's syndrome was controlled in 53.2% of cases (17/30) after the initial injection of botulinum toxin type A. Five of the 13 patients with recurrence of Frey's syndrome elicited to undergo a watch and wait policy due to the lack of discomfort induced by the recurrence. The remaining eight patients with recurrence of Frey's syndrome were successfully managed with a secondary intracutaneous injection of botulinum toxin type A. Such preliminary data, together with the review of the literature suggests, that the intracutaneous injection of botulinum toxin type A should now be the first line treatment option in patients with severe Frey syndrome.

[Results of intracordal injection of autologous fat in postoperative laryngeal paralysis]

OBJECTIVES

An analysis of the results achieved with intracordal autologous fat injection for unilateral laryngeal nerve paralysis after surgery.

PATIENTS AND METHOD

A study group of 46 patients with unilateral laryngeal nerve paralysis was treated by intracordal injection of autologous fat with a minimum follow-up of eight months. All patients had severe dysphonia and 39 had breathlessness. Twenty-nine patients had aspiration problems with difficulties in swallowing.

RESULTS

The only adverse side-effect was a subcutaneous abdominal hematoma in two patients and the development of an intracordal cyst in two patients. Aspiration disappeared immediately after the intracordal injection. Immediate improvement of speech, cough, and breathlessness was achieved in all patients. Over time, speech and voice, and swallowing remained stable in 67% and 80% of patients, respectively.

CONCLUSION

Such data suggest that the intracordal injection of autologous fat is a valuable method in patients with unilateral laryngeal nerve paralysis after surgery.

Chemotherapy combined with conservation surgery in the treatment of early larynx cancer

In the past 20 years, strategies based on the use of platinum-based induction chemotherapy regimens have been developed in an attempt to preserve the larynx, increase local control, and improve survival in patients with advanced laryngeal cancer. In patients with early-stage laryngeal cancer, it is commonly thought that there is no role for induction chemotherapy. In this review, we support the notion that there is growing evidence available in the literature documenting the need and the role for induction chemotherapy as well as the need and the role for the use of conservation laryngeal surgery after induction chemotherapy in early-stage laryngeal cancer (T1-2N0).

Carbon dioxide laser debulking for obstructing endolaryngeal carcinoma: a 10-year experience

The results of the carbon dioxide (CO2) laser debulking procedure for obstructing endolaryngeal carcinoma were analyzed in terms of efficiency, complications, secondary tracheotomy rate, and peristomal recurrence rate in a series of 50 patients consecutively managed at our department. The CO2 laser was used to reestablish a safe airway without resorting to tracheotomy and without performing a transoral resection. Our series included 42 patients in a pre-definitive treatment group (group 1) and 8 patients in a palliation group (group 2). Complications included death, pneumonia from inhalation, and cutaneous burns in 2 patients, 1 patient, and 1 patient, respectively. Thirty-two percent of patients required a repeat laser treatment to maintain the airway. Overall success rates of 92.8% and 87.5% were achieved in group 1 and group 2 patients, respectively. None of the variables under analysis could predict the success of the CO2 laser debulking procedure. The overall incidences for secondary tracheotomy were 4.7% and 0% in group 1 and group 2 patients, respectively. Peristomal recurrence was not encountered in patients managed with definitive therapy with curative intent.

[Fronto-naso-ethmoido-sphenoido-maxillo-orbital mucocele with ophthalmologic presentation]

PURPOSE

We present a case of a large mucocele pressing the orbit forward and compared our findings with those reported by others.

CASE REPORT

A 23-year-old woman was examined for an inflammatory tumor of the internal canthus. She had a 6/10 vision loss of the left eye, diplopia, and non-axial exophthalmos. CT scan and magnetic resonance imaging evidenced a huge sinus mucocele behind the orbit. Surgery using the paralateronasal approach was performed. Pathology confirmed the diagnosis of mucocele.

DISCUSSION

Ophthalmic complications of mucoceles result from tumor growth leading to compressive optic neuropathy or even compression of the chiasma. A sinus mucocele should be suspected upon indirect clinical signs and lead to neuroradiological explorations. Magnetic resonance imaging reveals iso- or high signals on T1-weighted sequences and high signal on T2-weighted sequences. MRI evidences intracranial or orbital extension. CT scan reveal the degree of bone erosion. Prognosis is favorable after surgical treatment. It is important to correctly diagnose mucocele on the basis of clinical and neuroradiological findings in order to propose early surgery and prevent permanent visual loss by compressive optic neuropathy.

Vocal function after vertical partial laryngectomy with glottic reconstruction by false vocal fold flap: durational and frequency measures

OBJECTIVE

Compare vocal function following vertical partial laryngectomy (VPL) with or without glottic reconstruction by false vocal fold (FVF) mucosal flap.

STUDY DESIGN

Twenty-seven patients with Tla squamous cell carcinoma (SCC) of the glottis were included in a prospective randomized clinical study. All patients were treated by frontolateral partial laryngectomy (FLPL). Glottic reconstruction with FVF mucosal flap was performed in 14 patients at the time of the FLPL, whereas 13 patients had standard FLPL.

METHODS

Objective voice assessment was based on computerized acoustic recordings performed before and 1 year after surgery. When possible, additional recordings were performed at 3 months, 6 months, and 2 years postoperatively. Incidence of postoperative granuloma and anterior neoglottic web were noted. Repeated analysis of variance (ANOVA) was used to compare the durational (maximum phonation time, speech rate) and frequency measurements (average fundamental frequency [Fo], standard deviation of Fo, jitter, shimmer, noise-to-harmonics ratio, degree of voice breaks) between patients with or without glottic reconstruction, postoperative granuloma, and anterior neoglottic web. Linear regression was used to study the evolution over time of the durational and frequency measurements.

RESULTS

Frequency measurements improved with time and were significantly better in patients treated with glottic reconstruction. In addition, glottic reconstruction decreased incidence of postoperative granuloma and anterior neoglottic web.

CONCLUSIONS

The FVF mucosal flap technique can improve vocal results in selected cases of Tla SCC of the glottis when FLPL is the adequate surgical treatment. false vocal folds; glottic reconstruction; vertical partial laryngectomy; vocal function.

CO2 laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vocal fold

OBJECTIVE/HYPOTHESIS

A clinical evaluation of CO2 laser endoscopic posterior partial transverse cordotomy (EPPTC) in patients with severely compromised airway due to bilateral paralysis of the vocal fold.

STUDY DESIGN

An inception cohort of 25 patients over a 10-year period.

METHODS

The CO2 laser EPPTC was unilateral in 15 patients and bilateral in 10. Variables were tested for potential statistical relation to successful rehabilitation of the airway.

RESULTS

The use of the CO2 laser never resulted in adverse side effects. Complications were not encountered. A one-step, successful restoration of the airway was achieved in 68% (17/25) of patients. In univariate analysis, the CO2 laser EPPTC was statistically more likely to be successful if bilateral EPPTC was performed (P = .018). None of the following variables--age, sex, cause of bilateral paralysis, prior treatment, laser parameters, and duration of postoperative antibiotherapy and oral steroids--was statistically related to a successful restoration of the airway. Revision CO2 laser EPPTC, performed in six patients, resulted in an overall 92% (23/25) rate for a successful restoration of the airway. The overall tracheotomy rate was 8% (2/25).

CONCLUSION

The authors' data confirm the safety, ease of performance, and efficiency of the CO2 laser EPPTC in patients with bilateral vocal fold paralysis. This report also suggests that the completion of bilateral CO2 laser EPPTC statistically increases the likelihood of restoring the airway in a one-step surgical procedure.

Recurrent gustatory sweating (Frey syndrome) after intracutaneous injection of botulinum toxin type A: incidence, management, and outcome

OBJECTIVE

To evaluate the duration of effectiveness of intracutaneous injection of botulinum toxin type A for gustatory sweating as well as the incidence, severity, management, and outcome of recurrent gustatory sweating.

DESIGN

An inception cohort with a minimum of 18 months of follow-up.

SETTING

A tertiary care center and university teaching hospital.

PATIENTS

Thirty-three patients with severe gustatory sweating.

INTERVENTION

Intracutaneous injection of 25 to 175 IU (mean, 86 IU) of botulinum toxin type A.

MAIN OUTCOME MEASURES

Analysis of the effectiveness of the intracutaneous injection of botulinum toxin type A using the Kaplan-Meier actuarial life-table method; completion of the Minor starch-iodine test in patients without symptomatic recurrent gustatory sweating; and the patients' self-assessment of the severity of the recurrent gustatory sweating.

RESULTS

The 1-, 2-, and 3-year actuarial estimate for symptomatic recurrent gustatory sweating was 27%, 63%, and 92%, respectively. In the 7 patients without symptomatic recurrent gustatory sweating, the Minor starch-iodine test revealed persistent gustatory sweating in 6, resulting in an overall 97% rate (32 of 33 patients) for recurrent gustatory sweating. No statistical relationship could be demonstrated between the duration of effectiveness, the incidence of recurrent gustatory sweating, the severity of recurrent gustatory sweating, and the following variables: age, sex, cause of gustatory sweating, skin surface involved, and dose of botulinum toxin type A injection. Within the group of 26 patients with symptomatic recurrent gustatory sweating, (1) the severity of the recurrent gustatory sweating was always reduced when compared with the severity of the initial gustatory sweating, and (2) the recurrent gustatory sweating always remained amenable to reinjection of botulinum toxin type A.

CONCLUSIONS

The present series demonstrated a linear regression in the effectiveness of the intracutaneous injection of botulinum toxin type A in patients with gustatory sweating, while no factors appeared to be statistically related to the duration of effectiveness and/or the incidence of recurrent gustatory sweating. However, because the severity of recurrent gustatory sweating is reduced when compared with the severity of the initial gustatory sweating and because recurrent gustatory sweating remains amenable to reinjection of botulinum toxin type A, we believe that the intracutaneous injection of botulinum toxin type A should become the first-line treatment option in patients with gustatory sweating.

A multimodal strategy for the treatment of patients with T2 invasive squamous cell carcinoma of the glottis

BACKGROUND

The current conservative standard of care for T2 squamous cell carcinoma of the glottis is either partial laryngectomy or radiation therapy.

METHODS

Based on an inception cohort of 100 patients with T2 squamous cell carcinoma of the glottis and a minimum of 3 years of follow-up, the present study documented the results achieved with a multimodal strategy using platinum-based induction chemotherapy and partial laryngeal surgery. Statistical analysis of survival and local control was based on the Kaplan-Meier actuarial life table method. Univariate analysis was performed to determine whether there was a correlation among various factors and toxicity, clinical response, histologic regression, local control, and survival.

RESULTS

A complete clinical response and a partial response after induction chemotherapy was achieved in 24% and 58% of patients, respectively. Complete histologic regression was noted in 31%. A significant statistical relation (P < 0.0001) was noted between a complete clinical response after induction chemotherapy and a complete histologic regression. The 5-year actuarial survival estimate was 85.8%. The 5-year actuarial local control estimate was 95.7% (97.7% if the vocal cord was mobile and 93.8% if the motion of the vocal cord was impaired). Salvage treatment resulted in an overall 99% rate of local control and a 95% rate of laryngeal preservation.

CONCLUSIONS

Because this represents a nonrandomized retrospective study, no definitive conclusions can be derived. However, when compared with the data reported in a large series using radiation therapy or partial laryngectomy alone, this 10-year experience suggests that, in patients with "early" invasive squamous cell carcinoma of the glottis, the use of platinum-based induction chemotherapy prior to a conventional conservative treatment modality should be investigated further.

[En bloc resection of the carotid axis in epidermoid carcinoma of the head and neck. Retrospective analysis of 7 cases]

En bloc resection of carotid artery involved by squamous cell carcinoma was performed in 7 patients from 1993 to 1997. Cerebral tolerance was tested with qualitative evaluation of cerebral blood flow during preoperative balloon test occlusion of the internal carotid artery. Four patients later underwent permanent carotid occlusion prior to en bloc resection, 2 patients underwent carotid ligation without reconstruction and one patient underwent carotid resection associated with carotid reconstruction. The preliminary neurovascular and carcinologic results are presented. One patient had definitive stoke postoperatively. Follow-up ranged from 3 to 34 months. Two patients died by the 6th and 26th postoperative month respectively. Among the remaining 5 patients, tumoral recurrence occurred in two. Two patients have survived more than 2 years, but one of them had local recurrence and distant metastases. Considering these data and the review of the literature, selection of patients after carcinologic and cerebral tolerance evaluation is important in order to improve survival and quality of life of these patients.

Speech and voice characteristics after near-total laryngectomy. A preliminary prospective study

Selected characteristics were prospectively compared in the speech and voice of 10 patients managed with near-total laryngectomy. Tape-recorded speech samples were measured for durational features with a stopwatch. Acoustic features were analyzed with the Computerized Speech Lab and the Multidimensional Voice Program from Kay Elemetrics. Speech and voice parameters recorded preoperatively were compared with the parameters recorded postoperatively. Our data corroborate the prior reported good quality of the voice and speech after near-total laryngectomy.

[Intra-cord injection of autologous fatty tissue and recurrent unilateral paralysis]

A prospective analysis of intracordal autologous fat injection for inferior laryngeal nerve paralysis of various origins was conducted in a series of 20 patients with a minimum 6 month follow-up. Adverse side effects were a sub-cutaneous abdominal hematoma, and a pseudo intracordal cyst in 1 patient. Aspiration, noted in 11 patients, disappeared immediately after the injection of fat in 10 patients. Subjective evaluation and objective acoustic recordings documented improvement in voice quality at 6 months. Three patients had a secondary reinjection of fat resulting in an overall 100% success rate. Such preliminary data, together with the review of the literature suggests, that intracordal autologous fat injection is a highly valuable treatment option in patients with unilateral inferior nerve paralysis.

Recovery of function after intracordal autologous fat injection for unilateral recurrent laryngeal nerve paralysis

The present report documents the successful outcome in three patients with a unilateral recurrent laryngeal nerve paralysis managed with an intracordal injection of autologous fat who ultimately experienced a complete recovery of function. Such data demonstrates the safety of intracordal autologous fat injection in patients who ultimately recover function.

[Vertical partial laryngectomy with false vocal cord flap reconstruction: carcinologic and functional results]

Glottic reconstruction with false vocal cord flap was carried out to improve vocal function after vertical partial laryngectomy. This retrospective study reports carcinologic and functional results of 77 patients operated by vertical partial laryngectomy with or without glottic reconstruction. Five years actuarial survival rate and tumoral control rate were 79% and 90% respectively, without significant differences between patients with or without glottic reconstruction. Vocal study found that supraglottic structures were involved in neoglottic closure in 47% of the patients. Anterior commissure web was statistically reduced in patients with glottic reconstruction. The carcinologic results of this study allow for glottic reconstruction at the time of vertical partial laryngectomy. Neoglottic closure and postoperative anterior commissure web are factors which could influence final vocal results.

Computerized tomography of the glottis after intracordal autologous fat injection

According to the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery, various surgical methods such as laryngeal framework surgery, laryngeal re-innervation, and injection laryngoplasty might be used to palliate inferior laryngeal nerve paralysis. In the present case report we document the survival and exact location of the boluses of autologous fat in one patient in whom this material was used for injection laryngoplasty.