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Kitamura K, Ishizuka S, Kim JH, Yamamoto H, Murakami G, Rodríguez-Vázquez JF, Abe SI. Development and growth of the temporal fascia: a histological study using human fetuses. Anat Cell Biol 2024; 57:288-293. [PMID: 38590096 PMCID: PMC11184431 DOI: 10.5115/acb.23.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/03/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
The temporal fascia is a double lamina sandwiching a thick fat layer above the zygomatic bony arch. To characterize each lamina, their developmental processes were examined in fetuses. We observed histological sections from 22 half-heads of 10 mid-term fetuses at 14-18 weeks (crown-rump length, 95-150 mm) and 12 near-term fetuses at 26-40 weeks (crown-rump length, 215-334 mm). The superficial lamina of the temporal fascia was not evident at mid-term. Instead, a loose subcutaneous tissue was attached to the thin, deep lamina of the temporal fascia covering the temporalis muscle. At near-term, the deep lamina became thick, while the superficial lamina appeared and exhibited several variations: i) a mono-layered thick membrane (5 specimens); ii) a multi-layered membranous structure (6) and; iii) a cluster of independent thick fasciae each of which were separated by fatty tissues (1). In the second and third patterns, fatty tissue between the two laminae was likely to contain longitudinal fibrous bands in parallel with the deep lamina. Varying proportions of the multi-layered superficial lamina were not attached to the zygomatic arch, but extended below the bony arch. Whether or not lobulation or septation of fatty tissues was evident was not dependent on age. The deep lamina seemed to develop from the temporalis muscle depending on the muscle contraction. In contrast, the superficial lamina developed from subcutaneous collagenous bundles continuous to the cheek. Therein, a difference in development was clearly seen between two categories of the fasciae.
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Affiliation(s)
- Kei Kitamura
- Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan
| | | | - Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea
| | - Hitoshi Yamamoto
- Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
| | | | - Shin-ichi Abe
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
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Maniaci A, Guarino P, Barillari MR, Del Zompo MR, Filauro M, Lionello M, Mannelli G, Russo G, Tascone M, Topazio D. Perceptual, aerodynamic and acoustic outcomes of surgical technique for sulcus vocalis patients: A systematic review and meta analysis. Am J Otolaryngol 2024; 45:104131. [PMID: 38071789 DOI: 10.1016/j.amjoto.2023.104131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/15/2023] [Accepted: 11/22/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND Sulcus Vocalis (SV) is a voice disorder characterized by the parallel invagination of the vocal fold epithelium that adheres to the vocal ligament. This condition disrupts the vibratory function, leading to glottal incompetence, hoarseness, and vocal impairment. Despite various proposed surgical techniques, a standardized treatment approach remains elusive. METHODS We conducted a comprehensive search across PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library for studies on SV treatment. The inclusion criteria comprised original studies comparing pre- and post-treatment vocal outcomes in SV patients, published in English. We excluded case reports, reviews, studies without continuous data, and patients with vocal scar/atrophy. RESULTS Fifteen observational studies were included (361 patients, 53.73 % male, average age 41.64 years). 80 % of these studies employed self-reported outcomes, while 81.25 % analyzed acoustic/aerodynamic data. The follow-up period varied from 4 to 44 months. All techniques significantly improved Voice Handicap Index (VHI) scores (p < 0.001). Dissective and combined techniques exhibited greater reductions in VHI-30/10 (p < 0.001). Maximum Phonation Time (MPT) improved significantly across all techniques (p < 0.001), with dissective techniques demonstrating superior MPT outcomes (p < 0.001). Jitter improved significantly for dissective and injective techniques (p < 0.001), as did Shimmer for all techniques (p < 0.001). Notably, combined techniques displayed the most significant reductions (p < 0.001). CONCLUSIONS Surgical treatments significantly improve subjective, aerodynamic, and acoustic outcomes in SV patients. Dissective and combined dissective/injective techniques appear to yield better perceptual and phonatory outcomes compared to injective techniques alone. Further research is necessary to establish the optimal treatment approach for SV.
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Affiliation(s)
- Antonino Maniaci
- Faculty of Medicine and Surgery, "Kore" University of Enna, Enna, Italy; Department of Biomedical and Biotechnological Science (BIOMETEC), University of Catania, 95123 Catania, Italy.
| | - Pierre Guarino
- Otolaryngology Unit, Santo Spirito Hospital, Pescara, Italy
| | - Maria Rosaria Barillari
- Department of Mental and Physical Health and Preventive Medicine, "L. Vanvitelli" University, Naples, Italy
| | - Maria Rita Del Zompo
- Section of Otolaryngology-Head and Neck Surgery, Department of Medicine, University of Perugia, 06123 Perugia, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Treviso, Italy
| | - Giuditta Mannelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Gennaro Russo
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | - Martina Tascone
- Department of Oncology, University of Turin, Orbassano, Italy
| | - Davide Topazio
- Department of Otolaryngology, Hospital 'Mazzini', Teramo, Italy
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Woo P. Platelet-rich plasma in treatment of scar, atrophy, and sulcus: Short- and long-term results. Laryngoscope Investig Otolaryngol 2023; 8:1304-1311. [PMID: 37899871 PMCID: PMC10601577 DOI: 10.1002/lio2.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/30/2023] [Accepted: 08/13/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Platelet-rich plasma (PRP) is rich in growth factors and is easily obtained from blood samples. Long-term data after PRP injection into the larynx should be improved. This study reports the short-term (3 months) and long-term (12 months) voice results after PRP injection. Materials and Methods Sixty-three patients with scars (n = 34), sulcus vocalis (n = 17), recalcitrant nodules (n = 5), atrophy (n = 4), or a combination of these (n = 3) were included (158 injections; median follow-up = 12.3 months). Stroboscopy, voice handicap index (VHI-10), and cepstral spectral index of dysphonia (CSID) before and after treatment (3 months) and at 12 months were tabulated. Results VHI-10 changed from 19.5 to 14 at 3 months and 21 to 15 in the long term. The CSID scores improved from 31 to 21 in the short term and 31 to 26 in the long term (p < 0.001, paired t-test). Patients reported improved vocal effort and stamina with slight VHI or CSID score changes. Stroboscopy revealed improved closure and mucosal waves. Patients with severe dysphonia were less likely to improve compared to those with mild to moderate dysphonia. Some patients showed short-term improvements and then deteriorated back to baseline CSID over time (p < .05, paired t-test). Conclusion Both short- and long-term improvements in voice following PRP injection have been reported. Patients with mild-to-moderate dysphonia had better outcomes. PRP injection is an alternative treatment for patients with mild-to-moderate dysphonia due to vocal fold scarring, sulcus, and atrophy. Level of evidence II Prospective case series treatment.
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Affiliation(s)
- Peak Woo
- Department of Otolaryngology, Head and Neck SurgeryIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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Yildiz MG, Sagiroglu S, Bilal N, Kara I, Orhan I, Doganer A. Assessment of Subjective and Objective Voice Analysis According to Types of Sulcus Vocalis. J Voice 2023; 37:729-736. [PMID: 34112548 DOI: 10.1016/j.jvoice.2021.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sulcus vocalis (SV) subtypes are difficult to diagnose. Non-invasive techniques are sometimes not feasible in the diagnosis. The study aims to demonstrate the effectiveness and applicability of objective and subjective voice analysis combined with videolaryngostroboscopic examination (VLS) in the diagnosis of SV types. MATERIAL AND METHODS This is a retrospective study that includes patients who presented to Phoniatric outpatient clinic with complaints related to voice and diagnosed with SV on VLS examination between 2017-2020. The SV type was determined based on VLS findings and the patients were categorized into respective groups. Between- and within-group assessment of objective and subjective voice analysis of SV types was conducted. RESULTS 47 patients were included in the study; Type I, Type II, Type III SV patients were 16, 17, and 14 in number, respectively. Fundamental frequency (F0) and Shimmer (%) values were significantly high in Type II and III SV cases, whereas the Maximum Phonation Time (MPT) was significantly low. GRBAS, Voice Handicap Index -10 (VHI-10), Reflux Symptom Index (RSI) scores were statistically significantly high in pathological SV and Voice Related Quality of Life (V-RQOL) scores were low. A moderate correlation between VHI-10 and V-RQOL and between RSI and V-RQOL was detected. CONCLUSIONS Objective and subjective voice analysis in Type II and III SV show a significant difference compared to Type I SV. The use of objective and subjective voice analysis combined with VLS examination can be helpful in the diagnosis of SV types.
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Affiliation(s)
- Muhammed Gazi Yildiz
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY.
| | - Saime Sagiroglu
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Nagihan Bilal
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Irfan Kara
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Israfil Orhan
- The department of ENT, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
| | - Adem Doganer
- The department of biostatistics, Kahramanmaraş Sütcü Imam university faculty of medicine, TURKEY
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van der Woerd B, O'Dell K, Castellanos CX, Bhatt N, Benssousan Y, Reddy NK, Blood T, Chhetri DK, Johns MM. Safety of Platelet-Rich Plasma Subepithelial Infusion for Vocal Fold Scar, Sulcus, and Atrophy. Laryngoscope 2023; 133:647-653. [PMID: 35822344 DOI: 10.1002/lary.30288] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/18/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To demonstrate the safety profile of platelet-rich plasma (PRP) as an injectable therapeutic for the treatment of vocal fold scarring and atrophy. METHODS Preliminary report on a prospective clinical trial of patients with vocal fold scar or atrophy undergoing unilateral vocal fold subepithelial infusion with autologous PRP. Enrolled patients underwent four subepithelial injections spaced 1 month apart. Adverse events were assessed peri and post-injection at each session. Patient-reported outcomes were collected at every visit using the Voice Handicap Index-10 (VHI-10) and Vocal Fatigue Index (VFI) questionnaires. RESULTS Twelve patients underwent unilateral vocal fold injection with autologous PRP prepared according to Eclipse PRP® system protocol. Forty-three injections were performed using a peroral or percutaneous approach. An average of 1.57 ± 0.4 cc (range 0.6-2.0 cc) injectate was used. All patients tolerated the procedure without difficulty or peri-procedural complications. The average duration of follow-up was 3.6 ± 1.8 months. No significant inflammatory reactions or adverse events were seen to date. There was statistically significant improvement in patient-reported outcomes at the 3 month follow up (n = 9) follow-up (mean ΔVHI-10 = 10.8, p < 0.001, mean ΔVFI = 18.9, p = 0.01, t test, paired two sample for means, two-tail). All nine patients who completed the series of four injections subjectively (yes/no) reported they were satisfied with the results. CONCLUSION This prospective study cohort demonstrated a favorable safety profile, with no adverse events or peri-procedural complications. Subjective improvements in vocal quality and reduction in vocal fatigue need to be clinically correlated with further study. LEVEL OF EVIDENCE 4 Laryngoscope, 133:647-653, 2023.
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Affiliation(s)
- Benjamin van der Woerd
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Karla O'Dell
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Carlos X Castellanos
- Department of Otolaryngology Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A
| | - Neel Bhatt
- Department of Otolaryngology-Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Yael Benssousan
- USF Health Voice Center, Department of Otolaryngology - Head & Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Neha K Reddy
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A
| | - Timothy Blood
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A
| | - Dinesh K Chhetri
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, California, U.S.A
| | - Michael M Johns
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Landa M, Ninchritz E, Álvarez L, Palicio I, Urreta I. Autologous Tragal Perichondrium Graft for Vocal Fold Scar and Sulcus Vocalis. J Voice 2021; 36:701-706. [PMID: 33934935 DOI: 10.1016/j.jvoice.2020.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
Between 2006 and 2016 in a Tertiary Academic Center, 11 patients underwent phonomicrosurgery with tragal perichondrium graft placement in Reinke's space for the treatment of sulcus (Ford type 2) and vocal fold scar. A total of six patients out of 11 had an additional autologous fat implantation in order to improve the glottic closure. We evaluated the functional outcome using the Spanish validated version of the VHI- 30 before and 6 months after the surgery. We also measured the subjective appreciation of the obtained outcome, a perceptual voice evaluation using GRBAS scale, and changes in videostroboscopy examinations concerning mucosal wave and glottic closure. In the VHI-30 questionnaire, we observed an improvement in all patients (six of which showed an improvement of 50% or more) with statistically significant results (P = 0.003), and no significant differences between sulcus (Ford type 2) and vocal cord scar patients (P = 0.7579). The results obtained from the single question assessing changes in voice quality showed a high improvement in seven patients. According to the GRBAS scale, all cases improved. Concerning the results of the videostroboscopy, two patients obtained very favorable results, eight of them presented a moderate recovery and only one improved slightly. The following complications were identified: two granulomas, a graft extrusion and a tragal infection. The tragal perichondrium used as an autograft in Reinke's space appears to be a safe and satisfactory choice, comparable to other grafts such as temporalis fascia or autologous fat.
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Affiliation(s)
- Mikel Landa
- Department of Otorhinolaryngology, University Hospital Donostia-San Sebastián, Spain.
| | - Elisabeth Ninchritz
- Department of Otorhinolaryngology, University Hospital Donostia-San Sebastián, Spain
| | - Leire Álvarez
- Department of Otorhinolaryngology, University Hospital Donostia-San Sebastián, Spain
| | - Idoia Palicio
- Department of Otorhinolaryngology, University Hospital Donostia-San Sebastián, Spain
| | - Iratxe Urreta
- Epidemiology unit, University Hospital Donostia-San Sebastián, Spain
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Woo P, Murry T. Short-Term Voice Improvement after Repeated Office-Based Platelet-Rich Plasma PRP Injection in Patients with Vocal Fold Scar, Sulcus, and Atrophy. J Voice 2021:S0892-1997(21)00081-3. [PMID: 33745803 DOI: 10.1016/j.jvoice.2021.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Improving the voice of patients with vocal atrophy, scar, and sulcus vocalis remains challenging. Platelet-rich plasma (PRP) is an autologous biological suitable for regenerative medicine. Office-based injections of PRP may serve as a source of improved wound healing. MATERIALS AND METHODS Thirty two office based injections of PRP were performed in 14 patients with scar, sulcus, and vocal atrophy (12 scars, 1 sulcus, and 1 atrophy). PRP was prepared using 20 cc blood draw and double centrifugation method. Injection laryngoplasty was performed using trans cervical or indirect trans oral technique (10 trans cervical, 22 trans-oral). Volume of PRP use was 0.5-0.7 cc per side. Injections varied from 1 to 3 injections at monthly intervals. Videostroboscopy, Voice Handicap Index (VHI-10), and an objective analysis of the voice using Cepstral Peak Prominence (Cepstral Spectral Index of Dysphonia) were recorded. An expert rater speech pathologist rated the audio and stroboscopy results. RESULTS Median follow-up was 15 months. No patients were made worse. The mean VHI-10 before the injection was 23. VHI-10 after the injection was 12.5 (P < 0.01). The mean Cepstral Spectral Index of Dysphonia score for CAPE-V sentence was 42.5 before the injection and 23.5 (P < 0.01) after the injection. The expert rater thought the post treatment was better (9/14 acoustic, 10/14 stroboscopy). Eleven of the 14 patients thought the intervention was worthwhile to repeat. The other 3 patients thought the improvement was transient. CONCLUSION Office PRP injection into the vocal fold of patients with scar, sulcus, and atrophy may result in short term voice improvements. It is a biological worth considering.
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Affiliation(s)
- Peak Woo
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Medical Center, New York, New York.
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda Health University, Loma Linda, California; Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Lahav Y, Malka-Yosef L, Shapira-Galitz Y, Cohen O, Halperin D, Shoffel-Havakuk H. Vocal Fold Fat Augmentation for Atrophy, Scarring, and Unilateral Paralysis: Long-term Functional Outcomes. Otolaryngol Head Neck Surg 2020; 164:631-638. [PMID: 32777994 DOI: 10.1177/0194599820947000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a debate regarding the durability of fat implants. Our experience and recent publications suggest fat implantation may deliver a long-lasting improvement. This study aims to present the long-term outcomes for vocal fold fat augmentation using strict harvesting, preparing, and implantation protocols. STUDY DESIGN A prospective cohort conducted between 2014 and 2020 (recruitment 2014-2017). SETTING An academic tertiary referral center. SUBJECTS AND METHODS Twenty-two patients with glottic insufficiency were enrolled: 11 had unilateral vocal fold paralysis (UVFP), and 11 had atrophy or scar. Harvested fat was injected unilaterally or bilaterally into multiple sites. Six of these patients also had simultaneous microlaryngoscopic removal of other benign glottic lesions. Outcome measurements included video stroboscopy; Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) score; Voice Handicap Index (VHI); and acoustic analysis, performed preoperatively, 3, 12, 24, and 36 months after surgery. RESULTS Ten augmentations were unilateral and 12 bilateral. Comparing the preoperative and 36-month postoperative periods, the mean VHI score improved from 73.45 (±22.78) to 44.88 (±28.93), P = .001, and the mean GRBAS decreased from 8.64 (±3.89) to 2.82 (±2.3), P = .001; 24 months postoperatively, the mean fundamental frequency decreased from 163.88 Hz (±41.61) to 150.44 Hz (±41.47), P = .012. Stroboscopic analysis revealed statistically significant improvement in mucosal wave propagation, phase closure, and phase symmetry. Best results were achieved in the UVFP subgroup. Computed tomography scans demonstrated long-term viability of the implanted adipose tissue. CONCLUSION Fat is an excellent source of autologous graft. With careful patient selection and proper surgical technique, fat is suitable for long-term correction of glottic insufficiency. Fat augmentation should be considered as a long-lasting or even permanent solution, rather than temporary.
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Affiliation(s)
- Yonatan Lahav
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Liron Malka-Yosef
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Doron Halperin
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology Head and Neck Surgery, Rabin Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bilateral medialization thyroplasty in patients with vocal fold atrophy with or without sulcus. Eur Arch Otorhinolaryngol 2020; 277:2023-2029. [PMID: 32240365 PMCID: PMC7286849 DOI: 10.1007/s00405-020-05933-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
Purpose To evaluate voice outcome after bilateral medialization thyroplasty in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus. Methods Retrospective cohort study on 29 patients undergoing bilateral medialization thyroplasty for vocal fold atrophy (14 procedures) or atrophy with sulcus (15 procedures) between October 2012 and November 2017. Voice data were collected and analyzed for the preoperative and the 3- and 12-month postoperative time point according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptual, acoustic and aerodynamic parameters. Failure rate was based on number of revisions within 12 months and non-relevant improvement (< 10 points) in VHI-30 at 12 months. Results There was a clinically relevant (≥ 15 points) and statistically significant improvement (p < 0.0001) in the VHI-30 (preoperative: 55.8 points; postoperative at 12 months: 30.9 points). Fundamental frequency for male subjects decreased significantly from 175 to 159 Hz (p = 0.0001). The pre- and post-operative grade of dysphonia was significantly lower in patients with atrophy compared to atrophy and sulcus (mean difference 0.70, p = 0.017). Conclusion Bilateral medialization thyroplasty is a valid treatment option for patients with atrophy with or without sulcus. Outcomes are comparable to other methods reported in literature. However, there is a great need for larger, prospective studies with long-term follow-up to gain more insight into the comparative voice outcomes for the different forms of surgery for patients with glottic incompetence due to atrophy with or without sulcus.
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González-Herranz R, Hernandez García E, Granda-Rosales M, Eisenberg-Plaza G, Montojo Woodeson J, Plaza G. Improved Mucosal Wave in Unilateral Autologous Temporal Fascia Graft in Sulcus Vocalis Type 2 and Vocal Scars. J Voice 2019; 33:915-922. [DOI: 10.1016/j.jvoice.2018.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Andreadis K, Hoffman K, D'Angelo D, Sulica L. Sulcus Vocalis: Results of Excision Without Reconstruction. Laryngoscope 2019; 130:2208-2212. [DOI: 10.1002/lary.28378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/31/2019] [Accepted: 10/10/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Katerina Andreadis
- The Sean Parker Institute for the Voice, Department of Otolaryngology–Head & Neck Surgery, Weill Cornell Medical College New York, New York U.S.A
| | - Katherine Hoffman
- Division of Biostatistics & Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College/NewYork‐Presbyterian Hospital New York, New York U.S.A
| | - Debra D'Angelo
- Division of Biostatistics & Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College/NewYork‐Presbyterian Hospital New York, New York U.S.A
| | - Lucian Sulica
- The Sean Parker Institute for the Voice, Department of Otolaryngology–Head & Neck Surgery, Weill Cornell Medical College New York, New York U.S.A
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Imaizumi M, Nakamura R, Nakaegawa Y, Dirja BT, Tada Y, Tani A, Sugino T, Tabata Y, Omori K. Regenerative potential of basic fibroblast growth factor contained in biodegradable gelatin hydrogel microspheres applied following vocal fold injury: Early effect on tissue repair in a rabbit model. Braz J Otorhinolaryngol 2019; 87:274-282. [PMID: 31711791 PMCID: PMC9422641 DOI: 10.1016/j.bjorl.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/19/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Postoperative dysphonia is mostly caused by vocal fold scarring, and careful management of vocal fold surgery has been reported to reduce the risk of scar formation. However, depending on the vocal fold injury, treatment of postoperative dysphonia can be challenging. Objective The goal of the current study was to develop a novel prophylactic regenerative approach for the treatment of injured vocal folds after surgery, using biodegradable gelatin hydrogel microspheres as a drug delivery system for basic fibroblast growth factor. Methods Videoendoscopic laryngeal surgery was performed to create vocal fold injury in 14 rabbits. Immediately following this procedure, biodegradable gelatin hydrogel microspheres with basic fibroblast growth factor were injected in the vocal fold. Two weeks after injection, larynges were excised for evaluation of vocal fold histology and mucosal movement. Results The presence of poor vibratory function was confirmed in the injured vocal folds. Histology and digital image analysis demonstrated that the injured vocal folds injected with gelatin hydrogel microspheres with basic fibroblast growth factor showed less scar formation, compared to the injured vocal folds injected with gelatin hydrogel microspheres only, or those without any injection. Conclusion A prophylactic injection of basic fibroblast growth factor -containing biodegradable gelatin hydrogel microspheres demonstrates a regenerative potential for injured vocal folds in a rabbit model.
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Affiliation(s)
- Mitsuyoshi Imaizumi
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan.
| | | | - Yuta Nakaegawa
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Bayu Tirta Dirja
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Yasuhiro Tada
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Akiko Tani
- Fukushima Medical University, School of Medicine, Department of Otolaryngology, Fukushima, Japan
| | - Takashi Sugino
- Shizuoka Cancer Center, Division of Pathology, Shizuoka, Japan
| | - Yasuhiko Tabata
- Kyoto University, Institute for Frontier Life and Medical Sciences, Department of Regeneration Science and Engineering, Laboratory of Biomaterials, Kyoto, Japan
| | - Koichi Omori
- Kyoto University, Department of Otolaryngology, Kyoto, Japan
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Pathophysiology of Fibrosis in the Vocal Fold: Current Research, Future Treatment Strategies, and Obstacles to Restoring Vocal Fold Pliability. Int J Mol Sci 2019; 20:ijms20102551. [PMID: 31137626 PMCID: PMC6567075 DOI: 10.3390/ijms20102551] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/21/2019] [Indexed: 12/22/2022] Open
Abstract
Communication by voice depends on symmetrical vibrations within the vocal folds (VFs) and is indispensable for various occupations. VF scarring is one of the main reasons for permanent dysphonia and results from injury to the unique layered structure of the VFs. The increased collagen and decreased hyaluronic acid within VF scars lead to a loss of pliability of the VFs and significantly decreases their capacity to vibrate. As there is currently no definitive treatment for VF scarring, regenerative medicine and tissue engineering have become increasingly important research areas within otolaryngology. Several recent reviews have described the problem of VF scarring and various possible solutions, including tissue engineered cells and tissues, biomaterial implants, stem cells, growth factors, anti-inflammatory cytokines antifibrotic agents. Despite considerable research progress, these technical advances have not been established as routine clinical procedures. This review focuses on emerging techniques for restoring VF pliability using various approaches. We discuss our studies on interactions among adipose-derived stem/stromal cells, antifibrotic agents, and VF fibroblasts using an in vitro model. We also identify some obstacles to advances in research.
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Management of Vocal Fold Scars by Concurrent Nanofat and Microfat Grafting. J Craniofac Surg 2019; 30:692-695. [DOI: 10.1097/scs.0000000000005206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Kanazawa T, Kazuya K, Ujimoto K, Daigo K, Kiyoshi M, Shoichiro I, Yusuke W. Safety and short-term outcomes of basic fibroblast growth factor injection for sulcus vocalis. Acta Otolaryngol 2019; 138:1014-1019. [DOI: 10.1080/00016489.2018.1497808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kurakami Kazuya
- Faculty of Medicine, Department of Otolaryngology, Yamagata University, Yamagata, Japan
| | - Konomi Ujimoto
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Komazawa Daigo
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Misawa Kiyoshi
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, Hamamatsu University, Hamamatsu, Japan
| | - Imayoshi Shoichiro
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Watanabe Yusuke
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
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Pathological sulcus vocalis: treatment approaches and voice outcomes in 36 patients. Eur Arch Otorhinolaryngol 2018; 275:2763-2771. [PMID: 30159728 PMCID: PMC6208720 DOI: 10.1007/s00405-018-5040-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This is a retrospective study to evaluate the results of surgical treatment of patients with pathological sulcus vocalis. METHODS Thirty-six patients with pathological sulcus underwent surgery and in 33 cases were performed additional injection laryngoplasty. The pre- and postoperative evaluation of patients included the GRBAS scale, stroboscopic, and objective acoustic voice assessment. The Voice Handicap Index questionnaire (VHI-30) was also used and the scores were obtained from 33 patients. RESULTS The stroboscopic evaluation showed significant improvement of amplitude, mucosal wave, and glottal closure after treatment (p < 0.001). The VHI-30 scores decreased considerably indicating improvement due to the treatment for all aspects measured by VHI (p < 0.05, or p < 0.01). In all domains of GRBAS scale, the differences between preoperative and postoperative assessment were statistically significant (p < 0.001). We observed a significant change in Shim and APQ parameters (p < 0.05). Improvement was also observed in the sAPQ parameter, but it was not statistically significant (p = 0.051). For the remaining acoustic parameters, no changes were observed. CONCLUSIONS The surgical procedure with supplementary injection laryngoplasty of the vocal folds is a good treatment option for pathological sulcus vocalis. The post-treatment self-assessment indicates the significant improvement in VHI, just as perceptual-acoustic evaluation of voice does. Patients with pathological sulcus frequently present with amplitude disturbances, what explains their significant improvement after treatment.
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Karle WE, Helman SN, Cooper A, Zhang Y, Pitman MJ. Temporalis Fascia Transplantation for Sulcus Vocalis and Vocal Fold Scar: Long-Term Outcomes. Ann Otol Rhinol Laryngol 2018; 127:223-228. [DOI: 10.1177/0003489417753224] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William E. Karle
- Department of Otolaryngology–Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Samuel N. Helman
- Department of Otolaryngology–Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Amy Cooper
- The Voice and Swallowing Institute, Department of Otolaryngology–Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Yuan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Michael J. Pitman
- The Voice and Swallowing Institute, Department of Otolaryngology–Head and Neck Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
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18
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Carroll TL, Dezube A, Bauman LA, Mallur PS. Using Trial Vocal Fold Injection to Select Vocal Fold Scar Patients Who May Benefit From More Durable Augmentation. Ann Otol Rhinol Laryngol 2017; 127:105-112. [DOI: 10.1177/0003489417746188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas L. Carroll
- Department of Otolaryngology, Harvard Medical School, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Aaron Dezube
- Department of Surgery, St. Elizabeth Medical Center, Brighton, Massachusetts, USA
| | - Laura A. Bauman
- Department of Rehabilitative Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Pavan S. Mallur
- Department of Otolaryngology, Harvard Medical School, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Cantarella G, Mazzola RF, Gaffuri M, Iofrida E, Biondetti P, Forzenigo LV, Pignataro L, Torretta S. Structural Fat Grafting to Improve Outcomes of Vocal Folds’ Fat Augmentation: Long-term Results. Otolaryngol Head Neck Surg 2017; 158:135-143. [DOI: 10.1177/0194599817739256] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Evaluating the long-term outcomes of vocal fold structural fat grafting. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Seventy-nine dysphonic patients (16-82 years; 55 with unilateral laryngeal paralysis and 24 with vocal fold scarring) underwent vocal fold fat injection. Fat was harvested by low-pressure liposuction and then processed by centrifugation. Refined fat aliquots were placed in the vocal fold and paraglottic space in multiple tunnels to enhance graft neovascularization. All patients were followed for 12 months, 15 for 3 years, and 5 for 10 years with videolaryngostroboscopy, maximal phonation time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS (grade, roughness, breathiness, asthenia, strain) perceptual evaluation. Laryngeal computed tomography (CT) and/or magnetic resonance imaging (MRI) studies were performed in 16 patients 3 to 28 months postoperatively; MRI was repeated in 5 cases 12 to 18 months after the first radiological study. Results The voice quality of all patients improved after surgery, and long-term stability was confirmed by MPT, GRBAS, and VHI ( P ranging between .004 and <.001). The results achieved 1 year postoperatively remained stable at 3 and 10 years. Videolaryn-gostroboscopy showed improved glottic closure in all patients despite a limited amount of fat resorption. CT and MRI demonstrated survival of the fat grafts in all of the 16 examined cases. Serial MRI scans showed no change in graft size over time. Conclusions The reported clinical and radiological data demonstrate that fat is an effective filler for permanent vocal fold augmentation if the refined micro-aliquots are placed in multiple tunnels.
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Affiliation(s)
- Giovanna Cantarella
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo F. Mazzola
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Michele Gaffuri
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Iofrida
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Pietro Biondetti
- Radiology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura V. Forzenigo
- Radiology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Otolaryngology Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Pitman MJ, Kurita T, Powell ME, Kimball EE, Mizuta M, Chang S, Garrett CG, Rousseau B. Vibratory function and healing outcomes after small intestinal submucosa biomaterial implantation for chronic vocal fold scar. Laryngoscope 2017; 128:901-908. [PMID: 29105772 DOI: 10.1002/lary.26883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/04/2017] [Indexed: 01/07/2023]
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.
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Affiliation(s)
- Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Institute, Columbia University Medical Center/New York Presbyterian, New York, New York, U.S.A
| | - Takashi Kurita
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Maria E Powell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Emily E Kimball
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Siyuan Chang
- Corning Research and Development Corporation, Painted Post, New York, U.S.A
| | - C Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Cobden SB, Oztürk K, Duman S, Esen H, Aktan TM, Avunduk MC, Elsurer C. Treatment of Acute Vocal Fold Injury With Platelet-Rich Plasma. J Voice 2016; 30:731-735. [DOI: 10.1016/j.jvoice.2015.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/21/2015] [Indexed: 11/27/2022]
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22
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Shiba TL, Hardy J, Luegmair G, Zhang Z, Long JL. Tissue-Engineered Vocal Fold Mucosa Implantation in Rabbits. Otolaryngol Head Neck Surg 2016; 154:679-88. [PMID: 26956198 DOI: 10.1177/0194599816628501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess phonatory function and wound healing of a tissue-engineered vocal fold mucosa (TE-VFM) in rabbits. An "artificial" vocal fold would be valuable for reconstructing refractory scars and resection defects, particularly one that uses readily available autologous cells and scaffold. This work implants a candidate TE-VFM after resecting native epithelium and lamina propria in rabbits. STUDY DESIGN Prospective animal study. SETTING Research laboratory. SUBJECTS AND METHODS Rabbit adipose-derived stem cells were isolated and cultured in three-dimensional fibrin scaffolds to form TE-VFM. Eight rabbits underwent laryngofissure, unilateral European Laryngologic Society type 2 cordectomy, and immediate reconstruction with TE-VFM. After 4 weeks, larynges were excised, phonated, and examined by histology. RESULTS Uniform TE-VFM implants were created, with rabbit mesenchymal cells populated throughout fibrin hydrogels. Rabbits recovered uneventfully after implantation. Phonation was achieved in all, with mucosal waves evident at the implant site. Histology after 4 weeks showed resorbed fibrin matrix, continuous epithelium, and mildly increased collagen relative to contralateral unoperated vocal folds. Elastic fiber appearance was highly variable. Inflammatory cell infiltrate was limited to animals receiving sex-mismatched implants. CONCLUSION TE-VFMs were successfully implanted into 8 rabbits, with minor evidence of scar formation and immune reaction. Vibration was preserved 4 weeks after resecting and reconstructing the complete vocal fold cover layer. Further studies will investigate the mechanism and durability of improvement. TE-VFM with autologous cells is a promising new approach for vocal fold reconstruction.
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Affiliation(s)
- Travis L Shiba
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Jordan Hardy
- Research Service, Department of Veterans Affairs, Los Angeles, California, USA
| | - Georg Luegmair
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Jennifer L Long
- Research Service, Department of Veterans Affairs, Los Angeles, California, USA Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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Pitman MJ, Cabin JA, Iacob CE. Small Intestinal Submucosa Implantation for the Possible Treatment of Vocal Fold Scar, Sulcus, and Superficial Lamina Propria Atrophy. Ann Otol Rhinol Laryngol 2015; 125:137-44. [DOI: 10.1177/0003489415601685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Evaluate the histologic effects of grafting porcine-derived small intestinal submucosa (SIS) into the vocal fold superficial lamina propria (SLP) layer for the potential treatment of vocal fold scar, sulcus and superficial lamina propria atrophy. Methods: Small intestinal submucosa was implanted into the right vocal fold SLP of 6 mongrel dogs. The left vocal fold served as a sham surgical control. At 2, 4, and 6 weeks postoperative, bilateral vocal fold specimens were evaluated histologically. Results: At 2 and 4 weeks, respectively, SIS-implanted vocal folds demonstrated moderate and mild inflammation and acute and chronic inflammation. At 6 weeks, inflammation was minimal and chronic. The 6-week specimens showed copious amounts of newly generated hyaluronic acid (HA) within the graft. There was no reactive fibrosis at 6 weeks. Conclusions: In the canine model, SIS appears safe for SLP grafting. Inflammation is similar to that of sham surgery. Small intestinal submucosa results in newly generated HA without concomitant fibrosis. Small intestinal submucosa has potential to be used in treatment of disorders with SLP, including vocal fold scar, sulcus, and atrophy. Studies evaluating the effect of SIS implantation on vocal fold function, as well as the ultimate fate of the graft, are required.
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Affiliation(s)
- Michael J. Pitman
- Otolaryngology- HNS, The Voice and Swallowing Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Jonathan A. Cabin
- Otolaryngology-Head & Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Codrin E. Iacob
- Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
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