Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite
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LARYNGOLOGY
Five‑year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite Karol Zeleník1,2 · Martin Formánek1,2 · Radana Walderová1,2 · Debora Formánková1,2 · Pavel Komínek1,2 Received: 17 August 2020 / Accepted: 5 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate 5-year voice outcomes of vocal fold augmentation (VFA) using autologous fat (AF) injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Methods Retrospective study of patients who underwent VFA between 2012 and 2015, with a 5-year follow-up. Patients with a glottic gap of ≤ 3 mm caused by unilateral vocal fold paralysis or vocal fold atrophy were included in the study. VFA was performed using AF injection via direct microlaryngoscopy in 17 patients, and using office-based CaHA injection in 19 patients. Subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection, and at 12 and 60 months post-VFA. Results Altogether 36 patients underwent VFA between 2012 and 2015, of whom 5 were excluded within 1 year post-VFA, and 2 were excluded between 1 and 5 years post-VFA. Of the remaining 29 patients, 3 (10.3%) underwent re-intervention at between 1 and 3 years post-VFA. Thus, the 5-year follow-up included 26 patients (72.2%; 11 males and 15 females). At 5 years after surgery, 73.1% of the patients were satisfied with their voice, with no significant between-group difference (P = 0.307). The mean improvement of VHI was 28.8 ± 17.82 in the autologous fat group versus 33 ± 26.24 in the CaHA group (P = 0.458). MPT improvement was also similar between the two groups: 6.2 ± 4.26 for the autologous fat group versus 6.3 ± 4.34 for the CaHA group (P = 0.667). Conclusions Both AF injection via direct microlaryngoscopy and office-based CaHA injection yielded good and comparable 5-year results. Keywords Glottic insufficiency · Autologous fat augmentation · Calcium hydroxylapatite · Voice handicap index · Maximal phonation time
Introduction For over 100 years, vocal fold augmentation (VFA) has been performed for treatment of glottic insufficiency, and yet no single long-term or permanent injection material has been deemed ideal for this purpose. Autologous fat (AF) and calcium hydroxylapatite (CaHA) are both commonly used to obtain long-term results, and are frequently discussed in * Karol Zeleník [email protected] 1
Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Ostrava, 17. listopadu 1790, 70800 Ostrava, Czech Republic
Department of Craniofacial Surgery, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
2
the literature [1–3], but data beyond 1 year of follow-up are scarce [4–10]. However, such information is highly important for patients, who typically hope that the effect of the surgery will be permanent. Moreover, when VFA is considered, patients often receive only limited counseling, wit
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