In a canine vocal fold, the free fascia graft is well tolerated and after 12 months a well-organized, collagen rich tissue is seen on histological sections. The findings are in accordance with clinical studies applying free fascia grafts.
According to these preliminary results, vocal fold augmentation by an injection of autologous fascia seems a simple, inexpensive, reliable and safe method to restore voice quality after unilateral vocal fold paralysis.
The objective of this study was to evaluate the effects on voice quality of augmentation by injection of minced fascia in patients with unilateral vocal fold paralysis. Preoperative and postoperative voice samples from 14 patients (6 men and 8 women; mean age, 59 years) were analyzed by computerized acoustic analysis and blinded perceptual evaluation. Statistically significant improvements were seen in perturbation measurements (jitter and shimmer), noise-to-harmonics ratio, and maximum phonation time. A panel of evaluators rated 10 of the 14 postoperative voices as normal or near-normal. Injection laryngoplasty with minced fascia offers a new, effective, well-tolerated, and inexpensive method to medialize a paralyzed vocal fold. The graft seems to survive well, as indicated by good vocal results with a follow-up ranging from 5 to 32 months.
The objective of this retrospective clinical review was to evaluate the long-term results of injection laryngoplasty with autologous fascia as a single, primary procedure in unilateral vocal fold paralysis. Forty-three patients who had undergone injection laryngoplasty between 1996 and 2003 entered the study. Clinical examination and videostroboscopy were performed and the voice handicap index was analyzed postoperatively. Pre- and post-operative evaluation included computerized acoustic analysis and perceptual evaluation. The results remained stable 3-10 years and were not affected by the length of follow-up, the delay from paralysis to surgery, or the age of the patient. Although most mean values of voice parameters were significantly improved, results in individual patients were difficult to predict. Poor results were especially related to cases caused by intrathoracic lesions. Wide glottal gaps should not be treated with fascia injection. Fascia is a stable graft and most suitable for cases with less severe glottal insufficiency.
Vocal fold augmentation by injection laryngoplasty is a simple and fast procedure. The aim of this prospective study was to assess the glottal closure and the travelling mucosal wave by videostroboscopic images after autologous fascia augmentation in unilateral vocal fold paralysis (UVFP) with a special reference to objective analysis of voice. A total of 14 UVFP patients with poor voice and open glottal gap were assessed by videostroboscopy, blinded perceptual evaluation of running speech and acoustical analysis of sustained vowel. Data were collected before the procedure and at a supplementary evaluation 5-32 months (mean: 13 months) after injection of autologous fascia deep into the paralysed vocal fold. Mean age was 59 years; there were eight women and six men. Frame-by-frame video analysis revealed that before the operation 10 out of 12 had large glottal gaps without any contact between vocal folds on phonation. After the procedure seven gaps were completely closed, four partly, and two had no mucosal contact in stroboscopic examination. Maximum gap between vocal folds decreased from 7.21 units to 1.65 units (paired t-test P<0.001). Mucosal wave amplitude symmetry and phase synchrony were present in most subjects with partial closure and phase synchrony in every patient with a proper glottic closure. A panel of listeners rated voice to be significantly better ( P<0.01) ) after the procedure, and the improvement in acoustical parameters was also statistically significant ( P<0.01). There was a good correlation between objective voice analysis and videostroboscopy. Residual glottal gap was the major reason for less than optimal postoperative voice. No signs of hampered mucosal wave were noticed. Videostroboscopy and objective voice analysis suggest that augmentation by autologous fascia does not induce scar or fibrous tissue in the subepithelial space. Slight over-correction should be attempted initially in order to accomplish sufficient augmentation. This might enhance complete glottic closure and improve the outcome.
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