Fascia augmentation of the vocal fold: Graft yield in the canine and preliminary clinical experience

Sanford G. Duke, Jay Salmon, P. David Blalock, Gregory N. Postma, James A. Koufman

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

Introduction: Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. Study Design: A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. Methods: Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. Results: In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; range, 7%-96%; P = .57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation. Conclusions: Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency.

Original languageEnglish (US)
Pages (from-to)759-764
Number of pages6
JournalLaryngoscope
Volume111
Issue number5
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

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Keywords

  • Collagen
  • Fascia lata
  • Fat graft
  • Glottal insufficiency
  • Injection augmentation
  • Lipoinjection
  • Phonosurgery
  • Vocal fold paralysis
  • Voice
  • Voice rehabilitation

ASJC Scopus subject areas

  • Otorhinolaryngology

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