Vocal Fold Fat Augmentation Is a Durable Treatment Option for Patients with Glottic Insufficiency

by Linda Kossoff •

What are the long-term outcomes for vocal fold fat augmentation using strict harvesting, preparing, and implantation protocols?

BOTTOM LINE

Fat is an excellent source for autologous grafts and, with careful patient selection and proper surgical technique, is suitable for long-term correction of glottic insufficiency.

BACKGROUND: Glottal insufficiency results in voice and swallowing dysfunction. Medialization or augmentation can improve glottal closure and reduce air leak. Medialization by injection augmentation can be achieved through use of synthetic and biologically derived materials, which absorb with time, or autologous grafts, including fat. There has been debate regarding the durability of fat implants.

Comment: The article shows excellent long-term follow-up on a series of vocal cord fat injections, showing that the fat graft material is quite long lasting for most patients. This would help remind practitioners of this very useful technique and reinforce its inclusion in treatment algorithms for vocal cord paralysis, atrophy, and scar. —Jonathan Bock, MD

STUDY DESIGN: Prospective cohort study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.

SYNOPSIS: For their study, researchers enrolled 22 patients (six women, 16 men, mean age 48.3 years) with glottic sufficiency, 11 of whom had unilateral vocal fold paralysis (UVFP), and 11 of whom had atrophy or scar. All of the patients were injected, unilaterally or bilaterally, with harvested fat into multiple sites, and were injected into the paraglottic space, deep to the ligament. Outcome measurements included video stroboscopy; grade, roughness, breathiness, asthenia, strain (GRBAS) score; voice handicap index (VHI); and acoustic analysis, performed preoperatively and then three, 12, 24, and 36 months after surgery. Comparing the preoperative and 36-month postoperative periods, the mean GRBAS decreased from 8.64 to 2.82, and the mean VHI score improved from 73.45 to 44.88. 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. Researchers state that these findings confirmed their hypothesis regarding the durability of fat augmentation as compared to other injectable materials as a long-term treatment for glottic insufficiency. Study limitations included the relatively small size and heterogenic etiologies of the study population.

CITATION: Lahav Y, Malka-Yosef L, Shapira-Galitz Y, et al. Vocal fold fat augmentation for atrophy, scarring, and unilateral paralysis: long-term functional outcomes. Otolaryngol Head Neck Surg. 2021;164:631-638.