The unsolved chapter of vocal fold scars and how tissue engineering could help us solve the problem

Abstract

Vocal fold scarring is a relatively small field in scar research with prerequisites found nowhere else. The deterioration of the delicate tri-layered micro-structure of the epithelium of the vocal folds leads to impaired vibration characteristics resulting in a permanent hoarse and breathy voice. Tissue engineering approaches could help to restore the pre-injury status. Despite a considerable progress in this field during the last years, routine clinical applications are not available so far. One reason might be that vocal fold fibroblasts, as the responsible cell type for fibrogenesis, have very particular properties that are only poorly characterized. Moreover, in vivo trials are costly and time consuming and a representative in vitro model does not exist so far. These particular circumstances lead to innovative in vitro strategies and concepts such as macro-molecular crowding that can also be applied in adjacent fields.

Tissue engineering-based therapeutic strategies for vocal fold repair and regeneration

“…(A) Schematic of the micro-structure of the vocal fold;[27] (B) Coronal histological images of the mid-membranous normal rat vocal fold stained with hematoxylin and eosin (H&E). Superficial to deep, the layers of the vocal fold include the stratified squamous epithelium (E), the lamina propria (LP) and thyroarytenoid muscle (M); (C) Coronal histological image of the mid-membranous scarred rat vocal fold three days following a scarification injury; the specimen demonstrates the early inflammatory response associated with injury.…”

In vitro evaluation of anti‐fibrotic effects of select cytokines for vocal fold scar treatment

“…Scarring in vocal fold lamina propria (LP) is a debilitating condition that can lead to voice disorders from hoarseness, fatigue or even total loss of voice based on severity of scarring . Upon scarring, healthy LP tissue is replaced by stiff, fibrotic tissue with a disorganized extracellular matrix (ECM).…”

Expression of tenascin‐C in a rat vocal fold injury model and its regulation of fibroblasts

“…Normal wound healing can lead to scar formation. Vocal fold mucosa scarring can result in dysphonia and reduced quality of life, and treatment remains a clinical challenge . Vocal fold healing is a dynamic process that involves many genes and proteins that play important roles at different periods of regeneration; these roles can vary in physiological and pathological conditions.…”

“…Vocal fold mucosa scarring can result in dysphonia and reduced quality of life, and treatment remains a clinical challenge. 1 Vocal fold healing is a dynamic process that involves many genes and proteins that play important roles at different periods of regeneration; these roles can vary in physiological and pathological conditions. However, some studies on vocal fold wound healing have been based on experiments performed in other organs, such as the skin and other mucosal systems.…”