Fat Implantation into Reinke's Space: A Histologic and Stroboscopic Study in the Canine

Abstract

The scarred vocal fold is a cause of persistent dysphonia after laryngeal trauma, microsurgery, and tumor resection. The loss of Reinke's space with scar and stiffness is the primary cause. This study explores the technical aspects of endoscopic implantation of fat as an autologous implant for restoring the bulk and pliability of the vocal folds. Fat from the buccal area was harvested and prepared in 6 dogs. A mucosal flap submucosal pocket was prepared by means of microlaryngoscopy instrumentation. The fat implant was placed into the submucosal pocket. The mucosal flap was sutured endoscopically. Six weeks later, the larynx was harvested and mounted, and vocal fold oscillation was studied while driven by a humidified flow source. The vibratory patterns were studied by stroboscopy. Histologic sections of the vocal folds were made in the coronal plane. All 6 specimens had histologic evidence of viable implanted fat and/or fibrous tissue at the implant site. The site of implantation was in the superior aspect of the vocal fold, but contributed to mass in vocal fold bulk. This increase in bulk histologically corresponded to stroboscopic evidence of increased mass. On stroboscopy, the implant side continued to demonstrate good vibratory function. The study shows that fat implantation can be carried out as an endoscopic procedure. Fat implantation may be useful as a surgical procedure for restoration of Reinke's space. It may be applicable in patients with scars, sulcus vocalis, or vocal fold atrophy.

Avaliação da deposição de colágeno após implante de fáscia lata e de gordura na prega vocal de coelho: estudo histomorfométrico

“…Literature provides a significant amount of articles emphasizing the inflammatory process resultant from vocal folds grafting, including qualification and cell typing, in an attempt of repairing pre-existent defects or those voluntarily caused by the lamina propria 22,23 . However, studies with the purpose of analyzing the scarring process caused by manipulation and grafts are rare.…”

Results of Magnetic Resonance Imaging Assessment, Acoustic Analysis, Phonatory Function and Perceptual Rating of Glottic Insufficiency before and after Fat Augmentation: Correlated with Subjective Rating

“…It is probable that fat injection into the vocal fold will result in migration of the overinjected fat into Reinke's space producing a softening effect to 'cover' the vocal fold [18]. When vocal fold mobility becomes more pliable, the acoustic analysis and phonatory function of the patients will be improved even with postoperative fat absorption.…”

Uso da gordura e fáscia muscular autólogas no tratamento da insuficiência glótica

“…Woo et al 21 did an experimental study on dog larynxes, using autologous fat implants through larynx microsurgery and slaughtered the animals after 6 weeks. They showed the presence of viable fat cells after this time, besides showing an increase in Reinke's space in comparison with the contralateral vocal chord.…”