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Bipedicled Vocal Fold Mucosal Flap: An Experimental Study

Published:September 24, 2020DOI:https://doi.org/10.1016/j.jvoice.2020.08.031

      Summary

      Objective

      To determine the dimensions of mucosal defects that can be covered by a bipedicled vocal fold mucosal flap.

      Methods

      We used 20 adults human larynges (10 of each gender) excised from cadavers, divided into 2 groups of 10 larynges (5 of each gender) each. In one group (the normal flap group), we created the largest possible bipedicled vocal fold mucosal flap and then quantified the dimensions of the largest defect that could be covered by displacing the flap medially. In the other group (the augmented flap group), the flap was augmented laterally with mucosa from the laryngeal ventricle and we determined whether the larger flap would effectively cover larger defects.

      Results

      The mean width of mucosal defect capable of being covered was 1.51 mm when the normal bipedicled flap was employed and was 1.67 mm when the augmented flap was applied. However, the difference was not statistically significant. We found that defect size correlated with vocal fold length, width and flap size in the normal flap group, whereas it correlated only with vocal fold length in the augmented flap group. The bipedicled flap is capable of covering larger defects in males.

      Conclusion

      Enlargement of a bipedicled vocal fold mucosal flap with laryngeal ventricular mucosa does not necessarily translate to an increase in the size of defect that can be covered. On average, the flap should be 30% larger than the width of the defect. The statistical model for predicting the defect size based on the vocal fold length, vocal fold width, and flap size has excellent predictive quality when a normal flap is employed.

      Key Words

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      REFERENCES

        • Hirano M
        Morphological structure of the vocal fold.
        Folia Phoniatr. 1974; 26: 89-94
        • Garrett CG
        • Coleman JR
        • Reinisch L
        Comparative histology and vibration of the vocal folds: implications for experimental studies in microlaryngeal surgery.
        Laryngoscope. 2000; 110: 814-824
        • Ford CN
        Advances and refinements in phonosurgery.
        Laryngoscope. 1999; 109: 1891-1900
        • Zeitels SM
        • Healy GB
        Laryngology and phonosurgery.
        N Engl J Med. 2003; 349: 882-892
        • Courey MS
        • Gardner GM
        • Stone RE
        • et al.
        Endoscopic vocal fold microflap: a three-year experience.
        Ann Otol Rhinol Laryngol. 1995; 104: 267-273
        • Tsuji DH
        • Kinchoku VM
        • Imamura R
        • et al.
        Bipedicled vocal fold mucosal flap use in phonomicrosurgery: case series.
        J Voice. 2020; ([published online ahead of print, 2020 Apr 20]) (S0892-1997(19)30431-X)https://doi.org/10.1016/j.jvoice.2020.01.009
        • Sataloff RT
        • Spiegel JR
        • Heuer RJ
        • et al.
        Laryngeal mini-microflap: a new technique and reassessment of the microflap saga.
        J Voice. 1995; 9: 198-204
        • Akst L.M.
        • Olds K.C.
        • Balicki M.
        • et al.
        Robotic microlaryngeal phonosurgery: testing of a “steady‐hand” microsurgery platform.
        The Laryngoscope. 2018; 128: 126-132
        • Mobashir MK
        • Mohamed AERS
        • Quriba AS
        • et al.
        Linear Measurements of vocal folds and laryngeal dimensions in freshly excised human larynges.
        J Voice. 2018; 32: 525-528
        • Jotz GP
        • Stefani MA
        • Pereira da Costa Filho O
        • et al.
        A morphometric study of the larynx.
        J Voice. 2014; 28: 668-672
        • Ximenes Filho JA
        • Melo ECM
        • Carneiro CG
        • et al.
        Correlação entre a altura e as dimensões das pregas vocais.
        Rev Bras Otorrinolaringol. 2003; 69: 371-374
        • Branco A
        • Todorovic Fabro A
        • Gonçalves TM
        • et al.
        Alterations in extracellular matrix composition in the aging larynx.
        Otolaryngol Head Neck Surg. 2015; 152: 302-307
        • Roberts T
        • Morton R
        • Al-Ali S
        Microstructure of the vocal fold in elderly humans.
        Clin Anat. 2011; 24: 544-551
        • Grellet M
        • Carneiro CG
        • Aguiar LN
        • et al.
        Técnica do retalho pediculado para correção do sulco vocal.
        Rev. Bras. Otorrinolaringol. 2002; 68: 75-79