Efficiency and durability of hyaluronic acid of different particle sizes as an injectable material for VF augmentation

Kim, Yeon Soo; Choi, Jae Won; Park, Ju-Kyeong; Kim, Yoo Suk; Kim, Hyun Jung; Shin, Yoo Seob; Kim, Chul‐Ho

doi:10.3109/00016489.2015.1070966

Cited by 11 publications

(10 citation statements)

References 21 publications

(25 reference statements)

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“…Restylane was used as the control material because it and related cross-linked stabilized hyaluronic acid-based materials have been used extensively in humans and rigorously studied in rabbits, guinea pigs, and canines. 15,[18][19][20][21][22][23] Restylane has been demonstrated to be very biocompatible, evoking very little tissue reaction aside from some capsule formation, with residence times of many months.…”

Section: Introductionmentioning

confidence: 99%

Vocal Fold Injection of Absorbable Materials: A Histologic Analysis With Clinical Ramifications

Zeitels

Chaves

et al. 2019

Ann Otol Rhinol Laryngol

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Objectives: Gels composed of carboxymethylcellulose (CMC) and cross-linked hyaluronic acid are commonly used as temporary or resorbable injectable materials for vocal fold medialization. However, there is limited information about tissue injection patterns, soft tissue reaction, degradation, and residence time, particularly for the newer CMC gels. Study Design: Prospective, laboratory. Methods: Ten canines underwent paraglottic (deep to the vocal ligament) microlaryngoscopic injection with about 100 µL (0.1 mL) of cross-linked hyaluronic acid (Restylane) in the right vocal fold and about 100 µl (0.1 mL) of CMC gel in the left vocal fold. Two commercial CMC gels of similar formulation (Prolaryn Gel and Renú Gel) were used in 5 animals each. Two subjects were sacrificed for histologic analysis at 3, 13, 29, 42, and 55 days. Results: Histology showed that injected Restylane formed cohesive ovoid-shaped aggregated implants with minimal dispersion, inflammation, or cellular invasion in all subjects. Approximately 86% of Restylane injected remained at 8 weeks, as estimated from postmortem, high-resolution magnetic resonance imaging scans. In contrast, histology showed that both CMC gels dispersed widely through fascial planes during and after injection within and outside the thyroarytenoid muscle fascicles. There was a robust macrophage and histiocyte phagocytic response, with moderate to severe inflammation noted around residual CMC gel at early time points, and at 6 to 8 weeks, very little free gel was observed. Conclusions: None of the studied materials induced a clinical inflammatory reaction on laryngoscopy such that they would be considered problematic or dangerous. Restylane demonstrated superior injection localization, tissue compatibility, and residence time. Both CMC gels did not localize well in the paraglottic region, and there was a robust inflammatory response, with clearance by macrophages and short residence time. These results suggest that CMC gels may have a more limited application than previously thought for vocal fold medialization in patients in whom the injection is being used to achieve voice enhancement while awaiting reinnervation. Level of Evidence: NA

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Section: Introductionmentioning

confidence: 99%

Vocal Fold Injection of Absorbable Materials: A Histologic Analysis With Clinical Ramifications

Zeitels

Chaves

et al. 2019

Ann Otol Rhinol Laryngol

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“…All of the studies were published between January 2010 and March 2021. In general, ten studies aimed to develop new formulation of biomaterials [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]; three studies focused in improving or characterizing current biomaterials [ 46 , 47 , 48 ]; one study investigated the effect of the biomaterials toward inflammation [ 49 ]; three studies intended to improve fabrication methods in order to produce better biomaterials [ 36 , 46 , 50 ]. The biomaterials studied in the included articles were carbomer hydrogel, micronized dermal graft tissue, crosslinked HA, HA with gelatine hydrogel, CaHA, carboxymethylcellulose (CMC), bovine collagen, micronized alloderm (Cymetra) (Lifecell Corp, Branchburg, NJ, USA), HA gel, carboxylic and hydroxylic multi-walled functionalized carbon, unequal particle sized middle viscosity and low viscosity HA, Rofilan (Laborata es Filorga, Lisbonne, Paris, France),Radiesse (Merz, Franksville, WI, USA),Restylane (Galderma Laboratories, Fort Worth, TX, USA), dextran beads in HA microsphere (MP), polyethylene glycol-diamine (PEG) microparticles, gelatine methacrylate MP, HA methacrylate, semi-IPN MP, glycol chitosan hydrogel, pluronic F127 with collagen, HA with poly(ethylene glycol) diacrylate (PEGDA) crosslinkers, silk protein based in HA suspension, resilin-like-polypeptide hydrogel, PEG30 hydrogel and polydimethylsiloxane (PDMS) with polydopamine (PDA).…”

Section: Resultsmentioning

confidence: 99%

In Vitro Evaluation of Biomaterials for Vocal Fold Injection: A Systematic Review

Baki

Lokanathan

et al. 2021

Polymers

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Vocal fold injection is a preferred treatment in glottic insufficiency because it is relatively quick and cost-saving. However, researchers have yet to discover the ideal biomaterial with properties suitable for human vocal fold application. The current systematic review employing PRISMA guidelines summarizes and discusses the available evidence related to outcome measures used to characterize novel biomaterials in the development phase. The literature search of related articles published within January 2010 to March 2021 was conducted using Scopus, Web of Science (WoS), Google Scholar and PubMed databases. The search identified 6240 potentially relevant records, which were screened and appraised to include 15 relevant articles based on the inclusion and exclusion criteria. The current study highlights that the characterization methods were inconsistent throughout the different studies. While rheologic outcome measures (viscosity, elasticity and shear) were most widely utilized, there appear to be no target or reference values. Outcome measures such as cellular response and biodegradation should be prioritized as they could mitigate the clinical drawbacks of currently available biomaterials. The review suggests future studies to prioritize characterization of the viscoelasticity (to improve voice outcomes), inflammatory response (to reduce side effects) and biodegradation (to improve longevity) profiles of newly developed biomaterials.

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“…HA is a commonly used material in injection laryngoplasty. However, it only lasts approximately 3 to 6 months [4]. In our patient series, two types of injection material were used: HA and HA-D. HA with dextranomer aims to increase the duration of the material with the permanence of the positive load of dextranomer.…”

Section: Discussionmentioning

confidence: 99%

“…It is biocompatible and rarely induces foreign body reactions or cell-mediated immune responses. Clinical studies have supported the safety and efficacy of HA for vocal fold augmentation [4].…”

Section: Introductionmentioning

confidence: 99%

Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study

Enver¹,

Azizli²,

Akbulut³

et al. 2021

Turk J Med Sci

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Background/aim: This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods: This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results: In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion: Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.

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Efficiency and durability of hyaluronic acid of different particle sizes as an injectable material for VF augmentation

Cited by 11 publications

References 21 publications

Vocal Fold Injection of Absorbable Materials: A Histologic Analysis With Clinical Ramifications

Vocal Fold Injection of Absorbable Materials: A Histologic Analysis With Clinical Ramifications

In Vitro Evaluation of Biomaterials for Vocal Fold Injection: A Systematic Review

Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study

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