Treatment of vocal fold scar by carbon dioxide laser and collagen injection: retrospective study on 12 patients

Abstract

Vocal fold scars are the result of injury to the vocal fold lamina propria. This condition leads to an impaired vibration and usually to poor voice quality. The purpose of our study was to compare the pre- and posttreatment voice assessment scores in patients treated by CO(2) laser-assisted freeing of the scar followed by collagen injection. A group of 12 patients (10 women and 2 men) with vocal fold scars was studied retrospectively. Voice assessment was based on stroboscopy and on perceptual scores using the Grade (G) of the GRABS scale, subjective evaluation by the use of the Voice Handicap Index (VHI), aerodynamic measurements [maximum phonation time (MPT) and phonation quotient (PQ)], and acoustical measurements (frequency range and low intensity). Stroboscopy showed an improvement on the mucosal vocal fold wave and on the glottic competence. The mean VHI was improved from 63.16 to 45.5; G from 2 to 1.41; MPT from 7.05 to 8.62 s; and PQ from 463.02 to 358.54 ml/s. CO(2) laser freeing of vocal fold scars followed by collagen injection, combined with speech therapy, improved significantly the aerodynamic parameters (efficiency of voice), but not the acoustical scores.

Radiation fibrosis of the vocal fold: From man to mouse

“…Treatment of these biogels with Tumor Necrosis Factor Alpha (TNF‐a) has been shown to also decrease vocal fold synthesis of collagen III, fibronectin, and MMPs 35. Collagen injections, in combination with CO 2 laser treatment of the scar, have been shown to increase glottal competence 36. Other forms of laser, such as pulse dye laser, have also been used to attempt to treat vocal fibrosis 37.…”

Management of Dysphonia After Radiation Therapy

“…This was initially described with cold instrumentation by Bouchayer and Cornut 37 but has also been adapted for focal scar release with CO 2 laser. 38 However, this has not been described-and may not be applicable-for treatment of diffuse scarring and fibrosis often exhibited in the delayed postradiation larynx. A second treatment strategy involves the use of pulse dye laser (PDL) to increase turnover of the extracellular matrix within the superficial lamina propria.…”

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

“…The amorphous morphology of Reinke’s edema, which includes the entire vocal fold length, makes surgery difficult [72]. To avoid irreversible scarring, the surgery should be performed carefully taking into account the vocal fold architecture [73], [74]. The traditional method of stripping the vocal folds is now obsolete.…”

“…In well-circumscribed scars, often appearing in the sulci vocales, special incision techniques or complete excision of the scar are can be performed [138]. Several different laser techniques can also be employed, most notably, pulsed dye laser [73], [143]. …”