Videostroboscopic assessment of unilateral vocal fold paralysis after augmentation with autologous fascia

Abstract

Vocal fold augmentation by injection laryngoplasty is a simple and fast procedure. The aim of this prospective study was to assess the glottal closure and the travelling mucosal wave by videostroboscopic images after autologous fascia augmentation in unilateral vocal fold paralysis (UVFP) with a special reference to objective analysis of voice. A total of 14 UVFP patients with poor voice and open glottal gap were assessed by videostroboscopy, blinded perceptual evaluation of running speech and acoustical analysis of sustained vowel. Data were collected before the procedure and at a supplementary evaluation 5-32 months (mean: 13 months) after injection of autologous fascia deep into the paralysed vocal fold. Mean age was 59 years; there were eight women and six men. Frame-by-frame video analysis revealed that before the operation 10 out of 12 had large glottal gaps without any contact between vocal folds on phonation. After the procedure seven gaps were completely closed, four partly, and two had no mucosal contact in stroboscopic examination. Maximum gap between vocal folds decreased from 7.21 units to 1.65 units (paired t-test P<0.001). Mucosal wave amplitude symmetry and phase synchrony were present in most subjects with partial closure and phase synchrony in every patient with a proper glottic closure. A panel of listeners rated voice to be significantly better ( P<0.01) ) after the procedure, and the improvement in acoustical parameters was also statistically significant ( P<0.01). There was a good correlation between objective voice analysis and videostroboscopy. Residual glottal gap was the major reason for less than optimal postoperative voice. No signs of hampered mucosal wave were noticed. Videostroboscopy and objective voice analysis suggest that augmentation by autologous fascia does not induce scar or fibrous tissue in the subepithelial space. Slight over-correction should be attempted initially in order to accomplish sufficient augmentation. This might enhance complete glottic closure and improve the outcome.

Our Experience of Medialization Thyroplasty with Freeze-Dried Cadaveric Human Fascia Lata in Unilateral True Vocal Cord Paralysis

“…In a similar study by Reijonen et al, most voice parameters significantly improved after injection laryngoplasty with autologous fascia (13). In another study by Rihkanen et al, video analysis revealed fewer large glottal gaps after augmentation with autologous fascia (14). In addition, the maximum gap between the vocal folds decreased from 7.21 to 1.65 units.…”

“…Use of fascia lata can minimize the risk of rejection, allergic reactions, scarring or fibrosis of the subepithelial space, and infection transmission; moreover, it shows effective results on voice analysis (14,17,18). In a study on fascia augmentation of the vocal fold, the mean fascia graft yield in the canine larynx was 33%, which suggests that significant overcorrection may be necessary to produce optimal results; however, their clinical experience did not indicate these trends (17).…”

Vocal Fold Augmentation with Injectable Polycaprolactone Microspheres/Pluronic F127 Hydrogel: Long-Term In Vivo Study for the Treatment of Glottal Insufficiency

“…[2] Bruening performed the first injection augmentation of the vocal folds using paraffin in 1911. [3] Since then, several injectable substances have been used to treat glottal insufficiency, including fat, [4] fascia, [5] gel foam, [6] collagen, [7] silicone, [8] Teflon, [9] and others. [10] Each of these substances has demonstrated limitations such as poor long-term durability, migration from the injection site, inflammation, granuloma formation, and interference with vocal fold vibration due to viscoelastic mismatch [11]–[13].…”