Histologic study of an autologous fat graft in the larynx of dogs with unilateral vocal fold paralysis.

OBJECTIVE: To determine the histologic finds of autologous fat graft (AFG) in 24 paralyzed canine left vocal folds 12 weeks after introduction. STUDY DESIGN: Animal model. Experimental prospective study. METHODS: Twenty-four mongrel dogs of both genders weighing 15 to 20 kg were divided into three study groups (SGs) of eight dogs each, whose larynges were grafted by vocal fold lipoinjection (VFL-SGA), vocal fold lipoinjection plus insulin (VFLI-SGB), and by fat graft medialization laryngoplasty (FGML-SGC), respectively, and observed for 12 weeks, followed by immediate sacrifice. All 24 dogs were submitted to left vagal and recurrent laryngeal nerve resection. All animals were confirmed to have a left vocal fold paralysis four weeks later, when 2 mL of autologous fat graft were placed inside the left paraglottic space. The larynges were removed at pre-established times and, after they were studied for remaining fat graft volume by magnetic resonance imaging, they were studied histologically to evaluate the influence of the different techniques on the histologic behavior of the graft. RESULTS: Each of the three study groups had its specific finds for fat graft detection and fat absorption, and its characteristics identified and compared statistically. The groups were not statistically different. CONCLUSION: The histologic findings for the AFG applied to a vocal fold were similar in groups VFL-SGA, VFLI-SGB and FGML-SGC 12 weeks after grafting, with no statistically significant differences between groups, and revealed an almost total loss of the grafted fat.

Complicações decorrentes do uso de prótese vocal

INTRODUCTION: Since 1873 when the first total laryngectomy was performed there is a scientific interest in develop and recover patients' verbal comunication. Great successes were done after 1979, that permitted the tracheoesophagical prosthesis be a reality. Even being a special conquest the vocal prosthesis has its complications. AIM: To evaluate its complications registered with the vocal prosthesis use and its relation with patients' clinical aspects and the prosthesis kind. METHODS: Ten total laryngectomised patients from the HCRP-FMRP-USP, Head and Neck ambulatory, were followed to complications manifestations with the prosthesis use. RESULTS: Complications as saliva and/or diet passage from the pharynx to the trachea, fungal infection, prosthesis dysfunction were registered and quantified in relation with radiotherapy and the prosthesis kind used. CONCLUSION: Even being a special development for patients' comunication and socialization, it offers some difficulties and complications that have to be observed and more studies are necessary to better evaluate these aspects.

INTRODUÇÃO: Desde a primeira laringectomia total, realizada em 1873, já se tem registro do interesse em se desenvolver e recuperar a comunicabilidade verbal desses pacientes. Porém grandes progressos foram observados depois de 1979, quando se pode contar com próteses traqueoesofágicas. Mesmo sendo um enorme progresso, as próteses vocais geram complicações. OBJETIVO: Avaliar as complicações com o emprego de próteses vocais e relaciona-las com fatores clínicos e tipo de prótese. MÉTODOS: Dez pacientes submetidos a laringectomia total portando prótese fonatória foram acompanhados no serviço de Cirurgia de Cabeça e Pescoço do HCRP-FMRP-USP buscando-se registrar as complicações e relaciona-las com fatores clínicos e tipo de prótese. RESULTADOS: Foram registrados: vazamento de saliva e/ou dieta da faringe para a traquéia, infecção fungica, ausência de função da prótese e esses achados foram quantificados avaliando-se os efeitos da radioterapia e do tipo de prótese usada. CONCLUSÃO: A prótese vocal apresenta dificuldades e complicações operacionais que merecem atenção e mais estudos são necessários para se ter o perfil mais completo destes aspectos.