Laryngeal lipotransfer: review of a 14-year experience.

OBJECTIVE: To determine the efficacy of lipotransfer for treatment of various vocal fold (VF) pathologies. STUDY TYPE: Retrospective review. METHODS: We reviewed retrospectively the indications for and techniques of laryngeal lipotransfer and its effect on glottic closure and mucosal wave. One hundred four patients treated with lipotransfer between 1997 and 2010 were screened for inclusion in this study. Fifteen patients were excluded. Strobovideolaryngoscopic examinations for the 89 included subjects were reviewed to determine the change in glottic closure and mucosal wave. The degree of improvement, if any, was graded as mild, moderate, or substantial. The population was divided into the following four groups for analysis: (1) single lateral lipoinjection, (2) combination of lipoinjection and thyroplasty, (3) multiple lipoinjections with or without other injection medialization procedures, and (4) lipoimplantation for treatment of VF scar. RESULTS: Lipotransfer was used alone and as an adjunct procedure to treat glottic insufficiency (GI) secondary to VF motion abnormality or vibratory margin pathology. Augmentation was accomplished either by lateral injection or by medial implantation through an access tunnel. Most patients showed a statistically significant improvement in glottic closure because of lipoinjection and in mucosal wave because of lipoimplantation. Few minor and no serious complications occurred. CONCLUSION: Laryngeal lipotransfer is safe and effective for treatment of GI and VF scar.

Complications of injection laryngoplasty using calcium hydroxylapatite.

OBJECTIVE: To report the adverse effects of using calcium hydroxylapatite (CaHA) paste as a vocal fold filler. METHODS: Approval of this study was obtained through the institutional review board at Drexel University College of Medicine. Sixteen patients had 22 vocal fold injections with CaHA paste to treat glottic insufficiency. The initial procedures were performed at three different institutions between January 2006 and August 2009. Diagnosis and treatment of the complications in all cases were performed at our institution. Pre- and postinjection mucosal waves were assessed using strobovideolaryngoscopy when possible. All stroboscopic examinations were reviewed independently. Decreases in amplitude and waveform were classified as mild, moderate, or severe. Implant location was examined using computed tomography (CT) scan with 1-mm cuts through the larynx in patients suspected of having implant malposition. Vocal fold function was compared before and after injection, as well as after implant removal in selected cases. Histological section of explanted material was obtained. Major and minor complications were noted in 19 vocal folds. RESULTS: Ten major complications were encountered after surgery at three institutions. These included four vocal folds with adynamic mucosa, six with a severely decreased wave, and two granulomas affecting the vibratory margin. CT scanning confirmed six cases of implant malposition (possibly migration). Six implants were removed through endoscopic lateral cordotomy between 2 and 24 months after injection. Mucosal wave function recovered in five vocal folds after explantation. Minor complications were encountered in nine additional vocal folds. These included tissue inflammation marked by edema, erythema, and mild-to-moderate mucosal wave restriction and hypervascularity. CONCLUSION: Injection laryngoplasty using CaHA paste has been regarded as an effective treatment for glottic insufficiency. In some patients, CaHA can cause an intense inflammatory reaction, potentially migrate, and compromise vocal fold function. It should be used with full understanding of the potential serious adverse reactions and risk of at least minor impairment of vibratory function.