Advertisement

Long-Term Effects of Fat Injection Laryngoplasty in Relation to the Injected Fat Volume in Patients With Unilateral Vocal Fold Paralysis

Published:September 17, 2022DOI:https://doi.org/10.1016/j.jvoice.2022.08.020

      Summary

      Objective

      To evaluate the improvements in vocal function and glottal form before and after autologous fat injection laryngoplasty in relation to the injected total fat volume in patients with unilateral vocal fold paralysis.

      Design

      Clinical study.

      Methods

      Seventy-three patients with unilateral vocal fold paralysis received fat injection laryngoplasty and were divided into low-volume injection (<3 mL; average, 2.0 mL) and high-volume injection (≥3 mL; average, 4.3 mL) groups. Voice function before and after fat injection laryngoplasty were examined by aerodynamics evaluations, pitch and intensity measurements, and acoustic analyses. The glottal form before and after fat injection laryngoplasty was determined by measuring the ratio of vocal fold bowing (bowing ratio) and the ratio of lengths between bilateral vocal process (width ratio) at an easy phonation under laryngeal endoscopic examination. The postoperative parameters were evaluated for a median period of four years after fat injection laryngoplasty. The differences between pre- and postoperative parameters were examined separately for each group by the paired t-test. For each variable, a comparison of the effects of surgery was conducted using an analysis of covariance model with the change between the pre- and postoperative values as a dependent variable and the preoperative value as a covariate.

      Results

      In both groups, all parameters of voice function and glottal form after surgery significantly improved in comparison to those before surgery. Maximum phonation time, amplitude perturbation quotient, and normalized noise energy for 0 to 4 kHz in the high-volume group improved more significantly in comparison to those in the low-volume group.

      Conclusions

      As a rough guide for males, injection of more than 3 mL of autologous fat to the vocal muscle layer is recommended for reliable improvement of voice function in patients with unilateral vocal fold paralysis.

      Key Words

      Abbreviations:

      AA (Arytenoid adduction), ANCOVA (Analysis of covariance), APQ (Amplitude perturbation quotient), BR (Bowing ratio), FIL (Fat injection laryngoplasty), HV (High volume), LV (Low volume), MFR (Mean flow rate), MPT (Maximum phonation time), NNEa (Normalized noise energy for 0 to 4 kHz), PPQ (Pitch perturbation quotient), RLNP (Recurrent laryngeal nerve paralysis), SPL (Sound pressure level), TP (Thyroplasty type I), UVFP (Unilateral vocal fold paralysis), WR (Width ratio)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Umeno H
        • Chitose S
        • Sato K
        • et al.
        Comparative study of framework surgery and fat injection laryngoplasty.
        J Laryngol Otol Suppl. 2009; : 35-41https://doi.org/10.1017/S0022215109005064
        • McCulloch TM
        • Hoffman HT.
        Medialization laryngoplasty with expanded polytetrafluoroethylene. Surgical technique and preliminary results.
        Ann Otol Rhinol Laryngol. 1998; 107: 427-432https://doi.org/10.1177/000348949810700512
        • Hoffman MR
        • Witt RE
        • Chapin WJ
        • et al.
        Multiparameter comparison of Injection laryngoplasty, medialization laryngoplasty, and arytenoid adduction in an excised larynx model.
        Laryngoscope. 2010; 120: 769-776https://doi.org/10.1002/lary.20830
        • Umeno H
        • Shirouzu H
        • Chitose S
        • et al.
        Analysis of voice function following autologous fat injection for vocal fold paralysis.
        Otolaryngol Head Neck Surg. 2005; 132: 103-107https://doi.org/10.1016/j.otohns.2004.09.016
        • Hartl DM
        • Hans S
        • Crevier-Buchman LC
        • et al.
        Long-term acoustic comparison of thyroplasty versus autologous fat injection.
        Ann Otol Rhinol Laryngol. 2009; 118: 827-832https://doi.org/10.1177/000348940911801201
        • Umeno H
        • Chitose S
        • Sato K
        • et al.
        Long-term postoperative vocal function after thyroplasty type I and fat injection laryngoplasty.
        Ann Otol Rhinol Laryngol. 2012; 121: 185-191https://doi.org/10.1177/000348941212100308
        • Laccourreye O
        • Papon JF
        • Kania R
        • et al.
        Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: Long-term results from the patient's perspective.
        Laryngoscope. 2003; 113: 541-545https://doi.org/10.1097/00005537-200303000-00027
        • Zaretsky LS
        • Shindo ML
        • deTar M
        • et al.
        Autologous fat injection for vocal fold paralysis: Long-term histologic evaluation.
        Ann Otol Rhinol Laryngol. 1995; 104: 1-4https://doi.org/10.1177/000348949510400101
        • Fang TJ
        • Lee LA
        • Wang CJ
        • et al.
        Intracordal fat assessment by 3-dimensional imaging after autologous fat injection in patients with thyroidectomy-induced unilateral vocal cord paralysis.
        Surgery. 2009; 146: 82-87https://doi.org/10.1016/j.surg.2009.02.005
        • Lin WY
        • Chang WD
        • Ko LW
        • et al.
        Impact of patient-related factors on successful autologous fat injection laryngoplasty in thyroid surgical treated related unilateral vocal fold paralysis- observational study.
        Medicine. 2020; 99: e18579https://doi.org/10.1097/MD.0000000000018579
        • Isshiki N.
        Vocal mechanics as the basis for phonosurgery.
        Laryngoscope. 1998; 108: 1761-1766https://doi.org/10.1097/00005537-199812000-00001
        • Nakamura M
        • Tokashiki R
        • Issiki N
        • et al.
        Over-injection of autologous fat in the vocal fold: How to remove the excess?.
        Eur Arch Otorhinolaryngol. 2009; 266: 1589-1593https://doi.org/10.1007/s00405-009-0990-z
        • Anticaglia JR
        • Hawkshaw M
        • Sataloff RT.
        Too much fat, a rare complication of injection medialization laryngoplasty: A case report.
        J Voice. 2005; 19: 296-299https://doi.org/10.1016/j.jvoice.2004.02.004