Summary
In this study are reported the laryngeal and vocal results obtained after a microflap
excision of benign vocal fold (VF) lesions and immediate implantation of esterified
hyaluronic acid (EHA) in the surgical wound. In a previous pilot study on 11 cases,
we have shown an excellent tolerance of this bioimplant. The objectives are to confirm
the innocuity of the technique, to demonstrate the laryngeal and vocal evolution at
short and long term, and to evaluate the eventual positive impact of EHA implantation
on the pliability of the superficial layer of the lamina propria (SLLP) and on voice.
This is a prospective and comparative study on 83 patients suffering from various
benign VF lesions. Thirty-three patients were implanted with EHA, whereas 50 patients
did not undergo implantation at the end of the microsurgical procedure. All patients
undergo rigid laryngoscopy and microflap excision procedure under general anesthesia.
After freeing up of the Reinke's space and creation of a mucosal microflap, a few
fibers of EHA are inserted in the surgical wound, before closure of the incision with
fibrin glue. Serial laryngeal and vocal assessments are performed in all patients
using videostroboscopy (Wolff and Xion), perceptual and objective voice evaluation
(MDVP software, Kay Elemetrics), and phonatory function measurements (Aerophone II). Pre- and early
postoperative means are compared by analysis of variance. Delayed and long-term evolution
of laryngeal and vocal data are compared by means of nonparametric statistical methods.
The longest follow-up in the implanted group is 4 years. Early postoperative results
are similar in both groups: a significant improvement of a majority of laryngeal and
vocal data is observed after microsurgery. In the long term, the two groups exhibit
a different behavior: further improvement of voice, as an ongoing process, is only
observed in the EHA implanted group, together with improvement of some videostroboscopic
characteristics. The nonimplanted group remains stable, with no further improvement
of the voice quality obtained after microsurgery. Excellent short- and long-term tolerance
of EHA implantation is confirmed by this larger series. The use of EHA implant in
microdissected SLLP is safe and leads to good laryngeal and vocal outcomes in the
treated patients. More interestingly, treated cases exhibit a continuous improvement
over a long period of time.
Key Words
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Article Info
Publication History
Published online: October 23, 2009
Accepted:
December 31,
2008
Received:
October 9,
2008
Identification
Copyright
© 2010 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
