Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis

• Published in: Acta otorhino-laryngologica italica 2018-06, Vol.38 (3), p.204-213
• Main Authors: Ricci Maccarini, A, Stacchini, M, Mozzanica, F, Schindler, A, Basile, E, DE Rossi, G, Woo, P, Remacle, M, Magnani, M
• Format: Article
• Language: English
• Subjects: Adipose Tissue - transplantation; Adult; Aged; Centrifugation; Feasibility Studies; Female; Fiber Optic Technology; Glottis; Humans; Injections; Laryngeal Diseases - etiology; Laryngeal Diseases - surgery; Laryngology; Laryngoplasty - adverse effects; Laryngoplasty - methods; Laryngoscopy; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Treatment Outcome; Vocal Cord Paralysis - complications
• ISSN: 1827-675X; 0392-100X; 1827-675X
• DOI: 10.14639/0392-100X-2012

The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.