RESUMEN
Introducción: Las células madres son células no especializadas capaces de transformarse en células con funciones específicas actuando como sistema de reparación. Las células madres mesenquimáticas (CMM) son las más utilizadas actualmente. La fibrosis cordal altera la estructura de las cuerdas vocales afectando seriamente su función, no existiendo hoy una terapia que pueda manejar exitosamente esta condición. Objetivo: Evaluar la acción de la inyección intraoperatoria e intralesional de CMM autólogas en el proceso de reparación de lesiones cicatriciales crónicas en cuerdas vocales en pacientes con fracaso previo a terapias habituales. Material y método: Estudio piloto prospectivo de 3 casos. Se realizó punción de cresta ilíaca para extracción de CMM de médula ósea, que se concentran y expanden. En una segunda etapa se realiza resección de fibrosis cordal bajo laringoscopía directa e inyección intralesional del concentrado de CMM. Se realizó seguimiento videoestroboscópico. Resultados: No hubo complicaciones en sitio de punción de cresta ilíaca ni en laringe tras la inyección. Se observó retorno de la vibración cordal en los 3 pacientes, con mejoría vocal importante en 2 de ellos. Conclusión: La inyección intralesional de CMM aparece como una alternativa promisoria en el manejo de la fibrosis cordal con molestias mínimas para el paciente, requiriendo de mayores estudios.
Introduction: Stem cells are unspecialized cells in the body capable of developing into specialized cells with specific functions workingas a repair system. Mesenchymal stromal cells (MSC) are the most currently used. Scarred vocal folds cause severe voice problems. Nowadays there is no therapy that can successfully treat this condition. Aim: Evaluate the results of intraoperative and intralesional injection of autologous MSCs in the repair and healing process of chronic scarred vocal folds in patients with prior failure to usual therapies. Material and method: Prospective pilot study that includes three patients. MSCs were isolated and expanded from bone marrow taken from the Iliac crest of the patients. In a second stage, fibrosis resection was performed under direct laryngoscopy, and MSCs were injected intralesionally. Patients were followed up using videostroboscopy. Results: There were no complications after iliac crest puncture or laryngeal injection. Vocal fold vibration appeared in all 3 patients, with significant improvement in voice quality in two of them. Conclusions: Local injection of mesenchymal stromal cells appears to be a promising alternative in management of scarred vocal fold with minimal discomfort for the patient. Further studies are needed.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Pliegues Vocales/cirugía , Cicatrización de Heridas/fisiología , Cicatriz/cirugía , Trasplante de Células Madre Mesenquimatosas/métodos , Trasplante Autólogo , Inyecciones Intralesiones , Proyectos Piloto , Estudios Prospectivos , Estudios de Seguimiento , Laringoscopía/métodosRESUMEN
BACKGROUND AND OBJECTIVES: Glottic incompetence resulting from the unilateral vocal cord paralysis can be improved by medialization of the paralyzed vocal cord. Recently, it has been thought that the autologous fat could be used as a good material for augmenting paralytic vocal cord. There were reports about long-term follow-up results concerning voluminous, histological and acoustic changes after autologous fat injection. Authors observed periodically the morphological and acoustic changes of autologous fat deposits which were injected into iatrogenically paralyzed vocal cord. MATERIALS AND METHODS: Eight mongrel dogs were injected with autologous fat into the iatrogenically paralyzed vocal cords, and were sacrificed at 1, 3, 6 months after the fat injection and observed histological and acoustic changes. RESULTS: The bulk of the fat graft lasted at least 3 months in this experiment. There were minimal evidence of inflammatoy changes, foreign body reaction and improvement of voice quality was noted in spectrography. CONCLUSION: The autologous fat injection appears to be a relatively safe and effective method for medializing the paralyzed vocal cord.