Vocal Fold Lipoaugmentation Provides Long-Term Voice Improvements for Glottal Insufficiency

What is the long-term effectiveness of vocal fold (VF) lipoaugmentation as a treatment for patients with glottal insufficiency?

BOTTOM LINE

Most patients who receive VF lipoaugmentation for glottal insufficiency experience a long-term benefit, although improvements in voice and swallowing taper over time.

BACKGROUND: Autologous fat injections into VFs have been used to treat glottal insufficiency. These differ from synthetic injectables in that they can avoid granuloma formation and negative voice changes and conform more naturally to existing structures. Although lipoaugmentation offers a long-term solution, direct comparisons of outcomes are complicated.

STUDY DESIGN: Systematic review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas.

SYNOPSIS: Researchers conducted a systematic search to identify articles related to VF lipoaugmentation effectiveness duration. Thirty-one articles comprising 764 patients were included in the final analysis. Eleven of the studies tracked patients for longer than one year. Primary endpoints included duration of effectiveness per patient-reported outcome measures, objective findings, and additional procedures performed. Indications for augmentation were VF paralysis (690 patients) and atrophy (74 patients). Researchers identified a broad range of autologous fat harvest sites, including the abdominal region (21 studies, 529 patients), thigh/abdomen (5 studies, 91 patients), and buccal/submental region (2 studies, 33 patients). Fat processing techniques and voice quality assessment tools varied widely. Objective measure reporting was not uniform across studies and included a variety of outcomes. Long-term improvement in voice outcomes was seen, with only 11 in 764 patients (1.4%) reporting no improvement in voice and/or swallowing. Within the first year, 71 of 608 patients (11.7%) reported a regression toward baseline. Beyond one year up to eight years, 27 of 214 patients (12.6%) reported regression from initial improvement. Study limitations included limited available data and variable report mechanisms.

CITATION: Luke AS, Logan AM, Gawlik AE, et al. Autologous lipoaugmentation long-term clinical outcomes: A systematic review. Laryngoscope. 2022;132:1042-1053.