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Hamdan AL, Hosri J, Daou CAZ, Ghzayel L, Hadi J, Saab MB, Kasti M, Mourad M. Office-Based Steroid Injection for Benign Lesions of the Vocal Folds: Case Series and Review of the Literature. J Voice 2024:S0892-1997(24)00095-X. [PMID: 38762397 DOI: 10.1016/j.jvoice.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To present the authors' experience on intralesional steroid injection (ILSI) for benign lesions of the vocal folds and a review of the literature. STUDY DESIGN Retrospective chart review. METHODS The medical records of patients with vocal folds nodules, polyps, Reinke's edema, laryngitis/localized edema, and vocal fold granuloma who underwent ILSI were reviewed. Disease regression was assessed by reviewing the video recordings of laryngeal endoscopy before and after surgery. Subjective and objective voice outcome measures were compared before and after office-based ILSI. RESULTS Forty-seven patients with 81 lesions were included. The most common lesion treated was Reinke's edema followed by vocal fold nodules. All patients who presented for follow-up (n = 37) had partial or complete regression of their disease. When stratified by disease type, vocal fold polyps showed the highest percentage of complete regression (66.7%) followed by vocal fold nodules (65%). The mean voice handicap index-10 (VHI-10) score of the study group dropped from 16.63 ± 6.95 to 6.21 ± 6.09 points (P < 0.001). Patients with vocal fold polyps had the highest drop in the mean VHI-10 score by 16.66 ± 4.73 (P = 0.026). There was no significant difference in the mean acoustic and aerodynamic parameters before and after office-based steroid injection. CONCLUSIONS ILSI is an effective treatment modality for benign lesions of the vocal folds leading to partial or complete disease regression and self-reported improvement in voice quality.
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Affiliation(s)
- Abdul-Latif Hamdan
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jad Hosri
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe Abi Zeid Daou
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lana Ghzayel
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaafar Hadi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mounir Bou Saab
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maher Kasti
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marc Mourad
- Department of Otolaryngology-Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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van den Broek EMJM, Heijnen BJ, van der Valk JC, Hendriksma M, Langeveld APM, van Benthem PPG, Sjögren EV. Long-term outcomes of bilateral medialisation thyroplasty in patients with vocal fold atrophy with or without sulcus. J Laryngol Otol 2024; 138:570-575. [PMID: 37781766 PMCID: PMC11063655 DOI: 10.1017/s0022215123001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Evaluate long-term voice outcome after bilateral medialisation thyroplasty in glottic insufficiency due to vocal fold atrophy with or without sulcus. METHODS Patients after medialisation thyroplasty for vocal fold atrophy with or without sulcus were identified. Long-term post-operative subjective voice outcomes (> 1 year) using Voice Handicap Index-30, subjective ratings on voice aspects and study-specific questionnaire were compared to pre-operative and shorter-term (1 year) values. RESULTS Thirty-six patients were identified, of which 26 were included (16 atrophy, 10 sulcus) with median follow up of 6.7 years. Mean Voice Handicap Index score at > 1 year (40.0) showed clinically relevant (≥ 15 for groups) and statistically significant improvement compared to pre-operative score (58.1) and remained stable compared to post-operative score (35.7) at one year. Ten patients (56 per cent) reported clinically relevant improvement (≥ 10) after more than five years. CONCLUSION Long-term improvement in subjective voice outcomes is attainable in a significant proportion of patients undergoing bilateral medialisation thyroplasty for atrophy with or without sulcus.
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Affiliation(s)
- Emke MJM van den Broek
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center, Utrecht, The Netherlands
| | - Bas J Heijnen
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jens C van der Valk
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Antonius PM Langeveld
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Paul G van Benthem
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of Otorhinolaryngology/Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Eckel HNC, Nolte A, Otte MS, Shabli S, Lang-Roth R, Klußmann JP, Hansen KK. 3D-exoscopic microlaryngoscopy in phonosurgery for glottic insufficiency. Eur Arch Otorhinolaryngol 2024; 281:855-861. [PMID: 38105362 PMCID: PMC10796486 DOI: 10.1007/s00405-023-08345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE We hypothesized that using a 3D-exoscope (3Dex) in microlaryngoscopic phonosurgery is non-inferior to using a standard operating microscope (OM). To compare the above, we utilized a 3Dex and an OM for microlaryngoscopic vocal fold augmentation with autologous fat in patients with glottic insufficiency and compared the procedure itself and the long-term impact of vocal fold augmentation on subjective and objective voice parameters in both groups. METHODS 36 patients with glottic insufficiency received microlaryngoscopic laryngeal augmentation with autologous fat. A 3Dex was utilized in 24 cases for visualization and compared to twelve cases in which an OM was used. Voice parameters were evaluated over a period of twelve months. RESULTS Comparison of operation time and voice parameters between the 3Dex and OM groups did not reveal significant differences. Significant improvement of mean voice quality in all parameters excluding roughness was observed at 3 and 6 months followed then by a slight decrease of voice quality parameters between the 6 and 12 months interval in both groups. CONCLUSION Our findings indicate no difference concerning operation time and outcome between the use of a 3Dex and an OM in phonosurgery. Our results highlight a significant voice improvement after vocal fold augmentation with autologous fat in glottic insufficiency mediated dysphonia. The smaller viewing system, better ergonomics for the primary surgeon and the assistant and a direct view for the entire surgical team make a 3Dex an interesting alternative for visualization in microlaryngoscopic phonosurgery.
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Affiliation(s)
- Hans N C Eckel
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany.
| | - Antonia Nolte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Martin S Otte
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Sami Shabli
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Jens P Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Kevin K Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpener Str. 62, 50931, Cologne, Germany
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Campagnolo AM, Priston J, Nickel V, Benninger M. Vocal Fold Fat injection for Glottic Insufficiency: Systematic Review. J Voice 2023:S0892-1997(23)00304-1. [PMID: 38142186 DOI: 10.1016/j.jvoice.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/25/2023]
Abstract
Vocal fold fat injection is a technique for treating glottic insufficiency (GI) resulting from various conditions. The use of fat as a graft has several advantages over other grafts. Similar pliability, and vibratory characteristics as a normal vocal fold, not causing foreign body reactions, having the potential to contain stem cells, and often can be done in the office. Long-term results, however, are unpredictable. The objective of this study is to carry out a systematic review of published articles using the technique of fat injection in the vocal folds. STUDY DESIGN Systematic review. REVIEW METHODS A literature search was conducted utilizing the combination of the following keywords "vocal folds fat injection," "laryngoplasty," and "autologous fat injection vocal folds." The criteria inclusion of the study for the systematic review were based on PICOTS (population, intervention, comparison outcome, timing, and setting) and Preferred Reporting Items for Systematic Reviews and Meta-analyses statements. Outcomes reviewed included technique, study duration, perceptual and acoustic analysis, and quality of life preoperation and 1-year postoperation. RESULTS A systematic review on PubMed, Cochrane, and Embase databases included 13 studies analyzing the data of 472 patients, that had fat injection laryngoplasty for treatment of GI. The causes of GI varied substantially across studies. Considerable heterogeneity across studies was found, including technique for harvest, processing the fat, site of injection, and acoustic analysis. In the studies that measured maximum phonation time (MPT) there was a significant improvement in a follow-up of at least 1 year after the injection. The patient's perception of vocal quality, measured by the Voice Handicap Index, also showed significant improvement in several studies after fat injection laryngoplasty. CONCLUSION Fat injection laryngoplasty seems to be safe and effective for GI for at least 12 months. Multiple studies show favorable outcomes, but the lack of control groups, the heterogeneity in inclusion criteria, nonstandardized techniques, and objective voice evaluations limit this evaluation.
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Affiliation(s)
- Andrea M Campagnolo
- Department of Otolaryngology-Head and Neck Surgery, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Felicio-Briegel A, Sharaf K, Haubner F, Echternach M. Primary injection laryngoplasty after chordectomy for small glottic carcinomas. Eur Arch Otorhinolaryngol 2023; 280:1291-1299. [PMID: 36197582 PMCID: PMC9899722 DOI: 10.1007/s00405-022-07663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this study was to analyze the short- and middle-term effects of primary injection laryngoplasty in patients having tumor resection within the same surgery concerning the vocal outcome. Injection laryngoplasty was performed after harvesting autologous adipose tissue via lipoaspiration. METHODS A prospective study was performed with 16 patients (2 female; 14 male) who received tumor resection and an injection laryngoplasty using autologous adipose tissue during a single stage procedure. Multidimensional voice evaluation including videostroboscopy, patient self-assessment, voice perception, aerodynamics, and acoustic parameters was performed preoperatively, as well as 1.5, 3 and 6 months postoperatively. RESULTS Results show an improvement in the roughness-breathiness-hoarseness (RBH) scale, voice dynamics and subjective voice perception 6 months postoperatively. Maintenance of Voice Handycap Index, jitter and shimmer could be observed 6 months postoperatively. There was no deterioration in RBH and subjective voice perception 2 and 6 weeks postoperatively. No complications occurred in the fat harvesting site. CONCLUSIONS Using the lipoaspiration and centrifugation approach, primary fat injection laryngoplasty shows short-term maintenance und middle-term improvement in voice quality in patients with vocal fold defect immediately after chordectomy 6 months postoperatively. Cancer recurrence rate is comparable to the reported cancer recurrence rate for laryngeal carcinoma and thus not elevated through primary augmentation.
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Affiliation(s)
- Axelle Felicio-Briegel
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Kariem Sharaf
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Frank Haubner
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Matthias Echternach
- Department of Otorhinolaryngology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Bhatt NK, Gao WZ, Timmons Sund L, Castro ME, O'Dell K, Johns MM. Platelet-Rich Plasma for Vocal Fold Scar: A Preliminary Report of Concept. J Voice 2023; 37:302.e17-302.e20. [PMID: 33446439 DOI: 10.1016/j.jvoice.2020.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Vocal fold atrophy and scar can lead to loss of normal superficial lamina propria, negatively affecting the vibratory function of the vocal fold. These changes can lead to dysphonia, vocal fatigue, decreased volume, and altered pitch. Treatment options for these conditions are limited. Platelet-rich plasma (PRP) consists of platelets, growth factors, and cytokines derived from the patient's own blood and is believed to activate tissue regeneration. The purpose of this study was to review the technical aspects of collecting PRP and injecting it into the vocal fold injection - based on our initial experience with this procedure. CASE A patient with vocal fold scar was identified and enrolled in an ongoing prospective clinical trial study of a series of 4 monthly subepithelial vocal fold PRP injections, which was temporarily halted due to the COVID-19 pandemic. Patient underwent a single injection of autologous PRP into the left vocal fold. There were no adverse events during the study period. Subjective improvement in voice was noted at 1 month after injection with subsequent return to baseline over the next 4 months. Videostroboscopy performed on postinjection day 1 and day 7 and demonstrated no concerning exam changes. Compared to the preinjection baseline, the patient-reported voice-handicap index-10 (VHI-10) and voice catastrophization index were similar at 4 months following injection (20 to 20 and 4 to 3, respectively). Independent perceptual analysis of voice showed improvement at 4 months postinjection, compared to baseline consensus auditory-perceptual evaluation of voice 60 to 44. CONCLUSIONS This preliminary report was part of a prospective trial investigating the use of PRP to treat vocal fold atrophy and scar. This work highlights the technical considerations for injecting PRP into the vocal fold. Planned prospective enrollment in this study will help to validate the safety and efficacy of PRP injections.
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Affiliation(s)
- Neel K Bhatt
- University of Washington Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington
| | - William Z Gao
- Department of Otolaryngology - Head and Neck Surgery, Georgetown University Medical Center, Washington DC
| | - Lauren Timmons Sund
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - M Eugenia Castro
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O'Dell
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Michael M Johns
- USC Voice Center, Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California.
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Role of Autologous Fat Grafting in the Conservative Treatment of Fecal Incontinence in Children. J Clin Med 2023; 12:jcm12041258. [PMID: 36835794 PMCID: PMC9964968 DOI: 10.3390/jcm12041258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Treatment of organic fecal incontinence in children, typical of anorectal malformations, is most often conservative; however, when necessary, it can be surgical. Autologous fat grafting, or lipofilling, can be used to improve fecal incontinence. We present our experience with the echo-assisted anal-lipofilling and its effects on fecal incontinence in children and on the quality of life of the entire family. Under general anesthesia, fat tissue was harvested according to the traditional technique, and processed in a closed system Lipogems® set. Injection of the processed adipose tissue was guided by trans-anal ultrasound assistance. Ultrasound and manometry were also used for follow-up. From November 2018, we performed 12 anal-lipofilling procedures in six male patients (mean age 10.7 years). Five children had a stable improvement in bowel function with Krickenbeck's scale scores going from soiling grade 3 pre-treatment in 100% of children to grade 1 post-treatment in 75% of them. No major post-operative complications developed. An increase in thickness of the sphincteric apparatus was shown at ultrasound during follow-up. The quality of life of the entire family, evaluated with a questionnaire, improved after the surgical treatment of the children. Anal-lipofilling is a safe and effective procedure to reduce organic fecal incontinence thereby benefiting both the patients and their families.
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Sanabria-Greciano L, Martínez-Ruiz-Coello M, Miranda-Sánchez E, García-García C, González-Herranz R, Plaza-Mayor G. Parálisis laríngea: infiltración temprana, evolución y factores pronósticos. REVISTA ORL 2022. [DOI: 10.14201/orl.29825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introducción y objetivo: La parálisis de las cuerdas vocales (CCVV) es una patología prevalente e incapacitante. El objetivo principal de este estudio es comparar la recuperación de la movilidad y funcionalidad de las CCVV, así como el requerimiento de tiroplastia en dos grupos de pacientes, los que se trataron con infiltración temprana con ácido hialurónico (GIT) y los no infiltrados (GNI). Método: Estudio retrospectivo observacional. Para formar el GNI se filtró la base de datos de 715 exploraciones de parálisis laríngeas y se seleccionaron 33 pacientes que cumplieran los criterios de inclusión. Para el GIT se incluyeron a los pacientes infiltrados por parálisis laríngea en los últimos 3 años (n=22). En el GNI se analizó como medida de resultado: la recuperación de la movilidad y funcionalidad de la cuerda y la necesidad de tiroplastia. En el GIT se midió, adicionalmente, la fecha de la infiltración. Resultados: Los resultados del GIT son significativamente mejores (p=0.001) en la recuperación de la movilidad de las CCVV. Se observa una reducción no significativa (p=0.14) en la necesidad de tiroplastia en los pacientes infiltrados. Existen diferencias significativas entre los pacientes con parálisis unilateral del GNI vs GIT (p=0.009), mientras que los grupos con parálisis bilaterales no son comparables entre sí, debido al compromiso de la vía aérea que sufren los pacientes con la cuerda en posición medial. Discusión: La infiltración con ácido hialurónico proporciona el tratamiento temporal del defecto de cierre glótico con baja tasa de complicaciones, prolongando el tiempo máximo de fonación y la funcionalidad de la cuerda vocal parética, pudiendo reducir tratamientos posteriores. Se ha propuesto como un tratamiento que puede mejorar la calidad de vida del paciente. Sin embargo, es importante seleccionar adecuadamente los pacientes, ya que no todos pueden ser candidatos. Conclusiones: La infiltración temprana con ácido hialurónico produce una mejoría significativa en la recuperación de la movilidad de las CCVV, lo que apoya su indicación precoz. Aunque se observa una necesidad menor de tiroplastia en el GIT, las diferencias no son significativas.
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Ng WC, Lokanathan Y, Baki MM, Fauzi MB, Zainuddin AA, Azman M. Tissue Engineering as a Promising Treatment for Glottic Insufficiency: A Review on Biomolecules and Cell-Laden Hydrogel. Biomedicines 2022; 10:3082. [PMID: 36551838 PMCID: PMC9775346 DOI: 10.3390/biomedicines10123082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Glottic insufficiency is widespread in the elderly population and occurs as a result of secondary damage or systemic disease. Tissue engineering is a viable treatment for glottic insufficiency since it aims to restore damaged nerve tissue and revitalize aging muscle. After injection into the biological system, injectable biomaterial delivers cost- and time-effectiveness while acting as a protective shield for cells and biomolecules. This article focuses on injectable biomaterials that transport cells and biomolecules in regenerated tissue, particularly adipose, muscle, and nerve tissue. We propose Wharton's Jelly mesenchymal stem cells (WJMSCs), induced pluripotent stem cells (IP-SCs), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), insulin growth factor-1 (IGF-1) and extracellular vesicle (EV) as potential cells and macromolecules to be included into biomaterials, with some particular testing to support them as a promising translational medicine for vocal fold regeneration.
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Affiliation(s)
- Wan-Chiew Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ani Amelia Zainuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Mes SD, Smajlović E, Heijnen BJ, Hendriksma M, Jansen JC, Langeveld APM, Sjögren EV. Multidimensional assessment of voice quality after injection augmentation of the vocal fold with autologous adipose tissue or calcium hydroxylapatite. Eur Arch Otorhinolaryngol 2021; 279:1967-1978. [PMID: 34846572 DOI: 10.1007/s00405-021-07193-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate short- and long-term outcome of injection augmentation with autologous adipose tissue (AAT) and calcium hydroxylapatite injection (CAHA) in patients with a unilateral vocal fold paralysis (UVFP). DESIGN/METHODS A retrospective cohort study was performed in patients diagnosed with UVFP, who had received injection augmentation with AAT or CAHA. Multidimensional voice analysis was performed before, 3 and 12 months after injection. This analysis included patient self-assessment (Voice Handicap Index-30), perceptual (overall dysphonia grade according to the GRBAS scale), aerodynamic (MPT, s/z ratio) and acoustic (fundamental frequency, dynamic range) parameters. Effects were assessed using a linear mixed model analysis. RESULTS Forty-six patients were available for evaluation, with a total of 53 injection augmentations (AAT n = 39; CAHA n = 14). We found significant improvement of patient self-assessment and perceptive voice outcome at 3 months, which were maintained at 12 months. In the CAHA group, s/z ratio and dynamic range of extreme frequencies also improved significantly over time. No statistically significant differences were found between the two treatments (AAT vs. CAHA). No major complications were reported. CONCLUSION This study, using a guide-line recommended panel of outcome parameters, shows a high success rate of injection augmentation with AAT or CAHA for patients with UVFP at 12 months with significant improvement in most voice outcome parameters, although voices do not completely normalize. There is no significant difference in outcome between the two materials.
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Affiliation(s)
- Stephanie D Mes
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Edela Smajlović
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bas J Heijnen
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Martine Hendriksma
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Jeroen C Jansen
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Antonius P M Langeveld
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Elisabeth V Sjögren
- Department of ENT, Head and Neck Surgery H5-Q, Leiden University Medical Center, Albinusdreef 2, Postbus 9600, 2300 RC, Leiden, The Netherlands
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11
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González-Herranz R, Navarro-Mediano A, Hernández-García E, Plaza G. Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia. Otolaryngol Head Neck Surg 2021; 167:118-124. [PMID: 34546813 DOI: 10.1177/01945998211045292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This series evaluates the long-term results of autologous adipose injection (AAI) in patients older than 65 years with presbyphonia. STUDY DESIGN Retrospective cohort study. SETTING Academic secondary medical center. METHODS This was a retrospective study with a minimum follow-up of 12 months. All patients underwent AAI for atrophy of both vocal folds due to presbyphonia. We measured subjective parameters as Voice Handicap Index-10 (VHI-10) or GRBAS scale (grade, roughness, breathiness, asthenia, strain) and objective measures such as maximum phonation time (MPT) or square pixel closure defect. We reviewed the medical records of patients undergoing AAI during the 2011-2018 period. An analysis of the demographic variables of the group was performed, as well as the values of VHI-10, GRBAS, and MPT, and the minimum closure defect measured in square pixels and the number of closed frames in the glottal cycle before and after the intervention. RESULTS At 12 months, 17 of 18 patients reported subjective and VHI-10 improvement. The mean preoperative VHI-10 (26.7) was significantly higher than the postoperative value (14.4), and the GRBAS scale had a preoperative mean of 8.7 and a postoperative mean of 4.3, both with statistical significance. MPT increased from 7.7 to 12.4 seconds (P < .0001). The minimum closure defect measurements obtained in square pixels changed from 305 to 124, achieving complete closure in 3 patients. The closed phase of the glottal cycle change from 14.3% to 38.2% after the AAI. CONCLUSIONS AAI improves long-term vocal fold closure, demonstrating utility in patients with presbyphonia.
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Affiliation(s)
- Ramón González-Herranz
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | | | - Estefanía Hernández-García
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
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Luke AS, Logan AM, Gawlik AE, Dion GR. Autologous Lipoaugmentation Long-Term Clinical Outcomes: A Systematic Review. Laryngoscope 2021; 132:1042-1053. [PMID: 34375001 DOI: 10.1002/lary.29802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/25/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold (VF) lipoaugmentation can be employed to treat glottal insufficiency although variable data exist on its length of effectiveness. We aimed to review published long-term outcomes following lipoaugmentation across the literature and compile outcome data. STUDY DESIGN Systematic review. METHODS A systematic search in September 2020 of PubMed, MEDLINE, Cochrane Library, and Web of Science used the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify 128 relevant articles related to VF lipoaugmentation effectiveness duration. Primary search terms included the following: vocal cord, fat, lipo, and atrophy. Forty-eight full-text articles were reviewed and 31 were included in the final analysis. Primary endpoints included the following: duration of effectiveness per patient-reported outcome measures, objective findings, and additional procedures performed. In addition, fat harvest location and processing techniques were recorded. FINDINGS Thirty-one studies totaling 764 patients were included in the review. Indications for augmentation were VF paralysis (N = 690) and atrophy (N = 74). Fat was harvested from the abdominal region in 21 studies (529 patients), the thigh/abdomen in 5 studies (91 patients), and buccal/submental region in 2 studies (33 patients). Processing techniques and injectable volume varied. Across included studies, only 11 of 764 patients (1.4%) reported no improvement in voice and/or swallowing. Within the first year, 71 of 608 patients (11.7%) reported a regression toward baseline. Beyond 1 year and up to 8 years, 27 of 214 patients (12.6%) reported regression from initial improvement. Thirty-three patients underwent additional procedures. CONCLUSION Although improvements in voice and swallowing after lipoaugmentation taper over time, most patients experienced long-term benefit. Laryngoscope, 2021.
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Affiliation(s)
- Alex S Luke
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, U.S.A
| | - Ashley M Logan
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, U.S.A
| | - Alexandria E Gawlik
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, U.S.A
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, U.S.A.,Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, U.S.A
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Gandhi S, Bhatta S, Ganesuni D, Ghanpur AD, Saindani SJ. Pre- and post-operative high-speed videolaryngoscopy in unilateral vocal cord paralysis following autologous fat augmentation. Am J Otolaryngol 2021; 42:102878. [PMID: 33418176 DOI: 10.1016/j.amjoto.2020.102878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare high-speed videolaryngoscopy (HSV) parameters such as open quotient (OQ), amplitude symmetry index (ASI), phase symmetry index (PSI), and frequency symmetry index (FSI), of the unilateral vocal cord paralysis (UVCP) patients pre and post (after 6 months) autologous fat augmentation. MATERIALS AND METHODS This retrospective study evaluated all age and gender patients with UVCP that underwent autologous fat augmentation from July 2016 to July 2019. The OQ, ASI, PSI, and FSI were calculated from the HSV recordings by using the montage and fast Fourier transform point analysis. The pre-and post-operative means were compared using a paired student t-test, with a p-value less than 0.05 considered significant. RESULT A total of 37 patients, age 41.2 ± 11.3 years (21 to 67 years), 59.4% females and 40.6% males, were included in the study. The average duration of symptom onset was 2.3 ± 0.87 months. The post-operative mean values of OQ, ASI, PSI, and FSI following the fat augmentation were significantly improved compared to the pre-operative mean values with p-values <0.0001, 0.0018, 0.0011, and 0.0006, respectively. CONCLUSION There was a significant improvement in the OQ, ASI, PSI, and FSI in UVCP patients after 6 months of autologous fat augmentation, signifying an enhanced vibratory function. The ability of HSV to measure the minute details of vocal cord vibration by providing quantitative measurements has also been highlighted. The need for future prospective research with an increased sample size and longer duration of follow up is recommended.
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