Intracordal Injection of Basic Fibroblast Growth Factor in 100 Cases of Vocal Fold Atrophy and Scar

Abstract

Objectives/Hypothesis Vocal fold atrophy, scar, and sulcus reduce the vibratory function of the vocal fold mucosa, which causes severe refractory dysphonia. We have reported encouraging preliminary results using an intracordal injection of basic fibroblast growth factor (bFGF) and showed improvement in phonatory parameters and voice. The present study summarizes our experience with 100 cases of stiffened vocal folds that were treated with bFGF injections. Study Design Retrospective chart review with Interstitial Review Board (IRB) approval. Methods Local injection of bFGF was performed in 100 cases of vocal fold pathology, which included 43 cases of vocal fold atrophy, 41 cases with scar, and 16 cases with sulcus. Ten micrograms of bFGF were injected into the vocal folds under topical anesthesia 4 times in each patient. Therapeutic outcomes were examined with maximum phonation time (MPT), voice handicap index‐10 (VHI‐10), and GRBAS scale. Results MPT, VHI‐10, and GRBAS scores significantly improved in all pathology groups. An improvement on the VHI‐10 greater than five points was observed in 82% of atrophy cases, 78% of scar cases, and 67% of sulcus cases. Improvement on the VHI‐10 was significantly better in the atrophy group than the scar or sulcus groups. The mild/moderate cases of scar and sulcus showed better improvement than severe cases. Conclusions The current large case series indicates positive effects of intracordal injection of bFGF for improvement of voice with no severe adverse events. The effects appeared best for cases of atrophy, while the treatment of severe scar and sulcus requires further improvement. Level of Evidence 4 Laryngoscope, 131:2059–2064, 2021

Long‐term results and safety of fibroblast growth factor injection for unilateral vocal fold paralysis

“…The delivery of external growth factors is a simple method that has been attempted in several fields 12 . In particular, bFGF—one of the major growth factors—has been used to treat vocal fold lesions 10,13–16 . bFGF injection stimulates the hyaluronic acid production and inhibits collagen production by proliferating the reduced fibroblasts in the superficial lamina propria (SLP) of atrophic vocal folds.…”

“…bFGF injection stimulates the hyaluronic acid production and inhibits collagen production by proliferating the reduced fibroblasts in the superficial lamina propria (SLP) of atrophic vocal folds. This increases the thickness of the SLP, thereby improving the symptoms of dysphonia caused by vocal atrophy and sulcus vocalis 15,17–19 . However, bFGF injection was most effective in prolonging the MPT of UVFP compared with other disease indicating that UVFP could be suitably treated with bFGF injections 10 .…”

“…This increases the thickness of the SLP, thereby improving the symptoms of dysphonia caused by vocal atrophy and sulcus vocalis. 15,[17][18][19] However, bFGF injection was most effective in prolonging the MPT of UVFP compared with other disease indicating that UVFP could be suitably treated with bFGF injections. 10 A sex-specific study on UVFP also demonstrated that bFGF injection improved MPT, mean airflow rate (MFR), and pitch range (PR) in patients, regardless of sex.…”

Injection laryngoplasty of human adipose-derived stem cell spheroids with hyaluronic acid-based hydrogel improves the morphological and functional characteristics of geriatric larynx

“…As presbylaryngis is a form of glottic insufficiency, it can be treated with methods to increase glottic contact, such as voice therapy, injection laryngoplasty, and medialization thyroplasty [ 7 – 9 ]. In addition to medialization by injection of space-occupying materials (e.g., calcium hydroxyapatite), the use of various substances, such as growth factors, platelet-rich plasma, and stem cells, has been examined to restore the sophisticated and unique structure of vocal-fold mucosa and muscles both in vivo and in clinical trials [ 10 – 12 ]. Regeneration of laryngeal tissues and restoration of intrinsic laryngeal functions are challenging problems that have yet to be addressed by existing injectable materials.…”

Injection Laryngoplasty of Human Adipose-derived Stem Cell Spheroids With Hyaluronic Acid-based Hydrogel Improves the Morphological and Functional Characteristics of Geriatric Larynx

“…As presbylaryngis is a form of glottic insu ciency, it can be treated with methods to increase glottic contact, such as voice therapy, injection laryngoplasty, and medialization thyroplasty [7][8][9]. In addition to medialization by injection of space-occupying materials (e.g., calcium hydroxyapatite), the use of various substances, such as growth factors, platelet-rich plasma, and stem cells, has been examined to restore the sophisticated and unique structure of vocal-fold mucosa and muscles both in vivo and in clinical trials [10][11][12]. Regeneration of laryngeal tissues and restoration of intrinsic laryngeal functions are challenging problems that have yet to be addressed by existing injectable materials.…”