Augmentation Autologous Adipose Injections in the Larynx

Abstract

Objective: Autologous adipose injection (AAI) is a recognized method for vocal fold augmentation. The study's purpose is to explore short-and long-term outcomes of AAI. Methods: Retrospective chart review of 43 patients undergoing AAI was performed; patient perception of outcome, Voice Handicap Index (VHI), maximum phonatory time (MPT), and disposition were evaluated. Results: Over 5 years, 43 AAI patients had documented postoperative follow-up (25 paralysis, 8 paresis, 9 bowing/presbylarynges, and 5 scar/sulci). Mean follow-up was 32 weeks. There was gradual patient loss to follow-up. Thirty-nine of 40 (98%) had patientreported improvement at 6 weeks, 28 of 34 (82%) had improvement at 2 to 6 months, with 10 of 12 (83%) sustaining their improvement for >1 year. Significant improvement in mean VHI was observed at 4 to 6 weeks (mean reduction, 26; P < .0001) and 2 to 6 months (mean reduction, 23; P < .0001). Improvement in mean MPT was observed at 4 to 6 weeks (mean increase, 8 s; P < .0001), 2 to 6 months (6 s; P = .007), and >1 year (4 s; P = .03). Eight patients went on to medialization laryngoplasty. Conclusion: AAI successfully augments vocal folds in short-term outcomes with some gradual decrease in effectiveness. Although patient attrition limited conclusions, objective long-term benefit may occur in >50% of patients.

The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency

“…According to our experience, the standard amount of 1 mL of Radiesse Voice is not always sufficient to achieve glottal closure, thus facilitating tissue vibration in the pretreated scarred larynx. In cases when a larger amount is needed, the augmentation with autologous periumbilical fat is a more suitable alternative . This procedure is also preferable due to the nonexistent cost factor of the injected substance and the simplicity of acquiring a sufficient quantity of material needed for the augmentation.…”

“…In cases when a larger amount is needed, the augmentation with autologous periumbilical fat is a more suitable alternative. 36 This procedure is also preferable due to the nonexistent cost factor of the injected substance and the simplicity of acquiring a sufficient quantity of material needed for the augmentation. However, up to now, no injection material exists that can restore the lamina propria or replace the ideal viscoelasticity of normal VFs.…”

Chirurgie des Larynx: Maligne Läsionen

“…Die Injektionsthyroplastik mit Fett wird auch als Primary Intracordal Autologous Fat Injection (PIAFI) bezeichnet [38]. Weitere Verfahren (auch in Kombination) zur Medialisierung der defizitären/exkavierten Stimmlippe sind die Thyroplastik mit Gore-Tex sowie die anteriore Kommissuren-Laryngoplastik, wobei der ipsilaterale Teil der Ala thyroidea nach Durchtrennung an die Innenseite des kontralateralen Teils subluxiert wird [45]. Narbenaugmentationen bei Narbentyp II und III mit autologem Knorpel (wegen der hohen Resorptionsstabilität wird Schild-/Septumknorpel empfohlen) können über einen transoralen oder transzervikalen Zugang erfolgen [43].…”

La presbifonía como causa de insuficiencia glótica

“…Por otra parte, el inconveniente de hacerlo en la consulta es que el procedimiento requiere de una curva de aprendizaje para el abordaje, bien realizando la inyección mediante nasofibroscopio de doble canal, vía transoral o vía transcervical, todas tienen la ventaja de comprobar la voz in situ, y de evitar los riesgos quirúrgicos de una población ya de por sí susceptiblemente frágil para procedimientos en el quirófano con anestesia general. La inyección del ácido hialuró-nico en las cuerdas vocales mejora la calidad de la voz en pacientes con insuficiencia glótica [14,15,16]. La cirugía, conocida como tiroplastia tipo 1 o de medialización, está destinada a casos donde hay una brecha glótica amplia y un adelgazamiento severo de la cuerda vocal.…”