Laryngeal framework surgery: current strategies

Heß, Markus; Fleischer, Susanne

doi:10.1097/moo.0000000000000308

Cited by 21 publications

(12 citation statements)

References 24 publications

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“…Various treatment options have been proposed to improve hoarseness due to UVFP. Vocal fold injection therapy and laryngeal framework surgery, such as medialization laryngoplasty and arytenoid adduction, are usually performed. However, these procedures provide only static adjustment to the larynx, and hoarseness often persists after treatment because of progressive atrophy of the denervated thyroarytenoid (TA) muscle, which may result in limited functional improvement.…”

Section: Introductionmentioning

confidence: 99%

Single, high‐dose local injection of bFGF improves thyroarytenoid muscle atrophy after paralysis

et al. 2019

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Objectives/Hypothesis: Unilateral vocal fold paralysis (UVFP) induces hoarseness due to progressive atrophy of the denervated thyroarytenoid (TA) muscle. Therefore, treatments aimed at regenerating the atrophied TA muscle are required. Basic fibroblast growth factor (bFGF) is involved in muscle development and regeneration. This study aimed to elucidate the effects of bFGF injection on atrophied TA muscle.Study Design: Animal research.Methods: A recurrent laryngeal nerve-paralysis rat model was established, and low-(200 ng) or high-dose (2,000 ng) bFGF or saline (control) was injected into the TA muscle 28 days later. The larynges were excised on day 1, 3, 7, 14, and 28 after treatment. The cross-sectional area of the TA muscle in normal and paralyzed sides was compared, and the Ki67-positive (Ki67 + ) dividing cells, paired box 7-positive (Pax7 + ) satellite cells (SCs), and myogenic differentiation-positive (MyoD + ) myoblasts were counted.Results: The TA muscle area of animals administered high-dose bFGF increased with time and was significantly larger than that of the saline-injected controls 28 days after treatment (P < .05). The counts of Ki67 + and Pax7 + cells were the highest on day 1, whereas the MyoD + myoblast count was highest on day 7. These results suggest that bFGF administration into the denervated TA muscles compensated for the atrophied TA muscles by inducing proliferation of SCs and their differentiation to myoblasts.Conclusions: A single injection of high-dose bFGF augmented regeneration and differentiation of the atrophied TA muscle by enhancing proliferation and differentiation of muscle SCs, suggesting its possible clinical application in humans with UVFP.

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Section: Introductionmentioning

confidence: 99%

Single, high‐dose local injection of bFGF improves thyroarytenoid muscle atrophy after paralysis

et al. 2019

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“…Arytenoid adduction is rarely performed in isolation, and debate exists regarding indications for addition of AA to ML. 20,26,[30][31][32][33][34][35][36] Furthermore, significant controversy remains as to whether ML+AA translates to clinically significant voice outcomes 28,30,32,33 and whether the potential increase in risk of postoperative complications, such as length of hospital stay, transient vocal fold edema, wound complications, and need for tracheostomy, 28,[37][38][39] justifies its use.…”

Section: Introductionmentioning

confidence: 99%

Voice outcomes following medialization laryngoplasty with and without arytenoid adduction

et al. 2018

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Objective Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA). Methods Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009–2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index‐10 (VHI‐10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE‐V) were assessed. Results Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI‐10 scores (P < 0.001), and CAPE‐V scores (P = 0.007). Baseline VHI‐10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI‐10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE‐V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates. Conclusion Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA. Level of Evidence 4 Laryngoscope, 129:1876–1881, 2019

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“…Some institutions will identify the need for AA preoperatively based on a large posterior glottic gap and arytenoid malrotation, whereas other institutions, including the University of California, San Francisco (UCSF) Voice and Swallowing center, intraoperatively decide to proceed with additional AA when voice results following ML are inadequate . In fact, there currently exists debate regarding whether addition of AA to ML is truly necessary …”

Section: Introductionmentioning

confidence: 99%

“…5 In fact, there currently exists debate regarding whether addition of AA to ML is truly necessary. 3,4,6,7 The main area of contention is whether ML-AA truly improves clinical outcomes; one study found greater improvement in acoustic and aerodynamic measures with ML-AA compared to ML or injection laryngoplasty, 4 but various articles subjectively evaluating posterior glottic gap have had contradictory findings. 5,8 However, there also is concern that the addition of AA increases complication rates.…”

Section: Introductionmentioning

confidence: 99%