Autologous Transplantation of Fascia into the Vocal Fold: Long‐Term Result of Type‐1 Transplantation and the Future

Abstract

Objectives: Since 1997, we have performed the autologous transplantation of fascia into the vocal fold (ATFV) procedure on cases of sulcus vocalis. In what follows, we report the long‐term results of our new surgical approach and discuss the role of these transplantations. We also review and report some complications that can be caused by ATFV. Finally, we discuss the ATFV technique as a contribution to the phonosurgery of the future. Study Design: Prospective study. Methods: We were able to obtain long‐term results from 10 volunteer cases (2 female and 8 male, age: 15–71, mean 46.5 years old) who could be followed up for at least 3 years after transplantation. All were cases of pathologic sulcus vocalis. We measured maximum phonation time (MPT) and carried out pre‐ and postsurgical clinical observation and laryngeal stroboscopy in all cases. These measurements and observations were made before the ATFV and at 6 months, 1 year, 2 years, and 3 years after surgery. Results: In stroboscopic observation 1 year after the ATFV, satisfactory glottal closure and excellent mucosal wave were observed for all cases, and there was no case with hyperadduction of the false vocal folds. MPT measures remained at an improved level 2 years and 3 years after the transplantations. Paired‐sample t tests showed that the improvement relative to preATFV levels was significant for all postsurgical measurements up to 3 years. Conclusions: We conclude that ATFV is a successful surgical procedure for sulcus vocalis and scarred vocal folds. Other phonosurgical clinical applications may also be envisioned.

Avaliação acústica e perceptivo-auditiva da voz nos momentos pré e pós-operatório da cirurgia de implante de pré-fáscia do músculo temporal

“…Tais achados concordam com a literatura que aponta pesquisas que estudaram patologias como paralisias, atrofi a, sulco e cicatriz de prega vocal, onde observa-se o comprometimento da coaptação glótica, tratados com substâncias como o tefl on, colágeno bovino, colágeno, gordura e fáscia autógena, e que não alcançaram valores de TMF dentro da normalidade 8,11,16,19,21,22 . ■ O único estudo que discorda com tal achado é justifi cado pelo fato de, ainda no momento pré-operató-rio, o valor do TMF já se encontrar muito próximo da normalidade 10 .…”

“…Várias pesquisas demonstram os resultados envolvendo o aumento do TMF, melhora da qualidade vocal na análise perceptivo-auditiva e melhora em algumas medidas acústicas quando se trata pacientes com paralisia, sulco vocal e cicatriz utilizando-se colágeno e gordura autógena e colágeno bovino [11][12][13][14][15][16][17] . Mais recentemente o tratamento para o sulco de prega vocal e de paralisia com a utilização de fáscia autógena foi descrito na literatura, sugerindo uma maior efetividade fonatória, anatômica e fi siológica [18][19][20][21][22] . Pesquisas utilizando a avaliação da voz por meio de análises perceptivo-auditivas, acústicas e aerodinâmicas têm fornecido dados clínicos importantes e uma melhor compreensão do impacto dos distúrbios vocais e efi cácia das intervenções cirúr-gicas 23 .…”

Allograft (Alloderm) and Autograft (Temporalis Fascia) Implantation for Glottic Insufficiency: A Novel Approach

“…Additionally, both have unique benefits, as the viscoelastic properties may improve the pliability of the vocal folds and fibroblasts within fascia and are believed to promote tissue regeneration within the vocal fold. 4,5,8 The effectiveness of fat as an implant material has been documented with injection into the paraglottic space, the thyroarytenoid muscle, and Reinke's space. [8][9][10] However, the preparation and injection process adversely affect the viability of injected cells with subsequent variable amounts of absorption, making whole ''en-bloc'' implants appealing, as documented with fat in Gray's minithyrotomy procedure.…”

“…A piece of sheet Alloderm is then introduced into the defect, and the cordotomy is reapproximated with 6-0 chromic suture. 4,5 In cases where the glottic insufficiency is minimal and where the patient prefers autologous graft instead of allograft, temporalis fascia can be harvested and placed into the defect, as described by Tsunoda et al 4,5 We performed a retrospective review of 21 patients who underwent 22 procedures for glottic insufficiency secondary to scar, atrophy, or sulcus. Demographic information was extracted, along with clinical information pertinent to their pathology.…”

Sulco vocal: provável etiologia genética. Relato de quatro casos em familiares

“…Sulcus vocalis treatment choice depends on the degree of glottic failure and vocal alterations, and include: injections of collagen, Teflon, hyaluronic acid, fat grafting and temporal muscle pre-fascia grafting; thyroplasty, mucosal slicing and sulcus ressection 4,5,6 . In the present investigation, only the patient from case 2 was submitted to surgery, using fat grafting.…”