Vibratory function and healing outcomes after small intestinal submucosa biomaterial implantation for chronic vocal fold scar

Abstract

Objectives/Hypothesis Vocal fold scar is a major cause of dysphonia, and optimal treatments do not currently exist. Small intestinal submucosa (SIS) is a biomaterial developed for the treatment of a variety of pathologies. The purpose of this study was to investigate the effects of SIS implantation on tissue remodeling in scarred vocal folds using routine staining, immunohistochemistry, and high‐speed videoendoscopy (HSV). Study Design Prospective, blinded group analysis. Methods Thirteen New Zealand White rabbits underwent a vocal fold scarring procedure followed by microflap elevation with or without SIS implantation. Seven months later, they underwent a phonation procedure with HSV and laryngeal harvest. Alcian blue and elastica van Gieson staining and immunohistochemistry for collagen types I and III were used to evaluate histological healing outcomes. Dynamic functional remodeling of the scarred vocal fold in the presence of SIS implants was evaluated using HSV imaging to capture restoration of vibratory amplitude, amplitude ratio, and left‐right phase symmetry. Results Density of collagen I was significantly decreased in SIS versus microflap‐treated vocal folds. No differences were found between groups for hyaluronic acid, elastin, or collagen type III. Organization of elastin in the subepithelial region appeared to affect amplitude of vibration and the shape of the vocal fold edge. Conclusions SIS implantation into chronic scar reduced the density of collagen I deposits. There was no evidence of a negative impact or complication from SIS implantation. Regardless of treatment type, organization of elastin in the subepithelial region may be important to vibratory outcomes. Level of Evidence NA. Laryngoscope, 128:901–908, 2018

An investigation of left–right vocal fold symmetry in rheological and histological properties

“…C). The results of fibrous proteins (i.e., collagen, elastin) distributions were in good agreement with those obtained by immunohistochemical staining, trichrome staining, and elastin van Gieson staining . Fig.…”

“…D). Similar Alcian blue staining pattern and the “band of hyaluronic acid” in rabbit vocal fold lamina propria had been reported. Histological examination showed that there were no appreciable differences in the morphological distributions of the key ECM constituents between the left and right vocal folds in all subjects.…”

“…Elastin staining was highly intense along the epithelium-lamina propria border, as previously reported. 28,29 To the contrary, staining for elastin was rather sparse in the lamina propria, with its intensity slightly increased in the deeper aspect (Fig. 4C).…”

“…The results of fibrous proteins (i.e., collagen, elastin) distributions were in good agreement with those obtained by immunohistochemical staining, trichrome staining, and elastin van Gieson staining. 1,4,28,29 Fig. 4E shows that Alcian blue staining was quite intense throughout the vocal fold lamina propria, except in the region bordering the epithelium, where hyaluronic acid was highly concentrated (Fig.…”

The Ability of Conditioned Media From Stem Cells to Repair Vocal Fold Injuries

“…No definite treatment for vocal fold scarring has been established, although a number of treatments have been attempted, including voice therapy, replacement of the extracellular matrix (ECM) of the vocal fold, a tissueengineering approach using several types of cells and growth factors, and new surgical techniques. [1][2][3][4][5] However, the ECM does not return to normal after replacement. Therefore, the prevention of scar formation is important in vocal fold wound healing.…”