Efficacy of trans-nasal fiberendoscopic injection laryngoplasty with centrifuged autologous fat in the treatment of glottic insufficiency due to unilateral vocal fold paralysis.

SUMMARY: The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.

Trans-tracheostomic endoscopy of the larynx in the evaluation of dysphagia.

Laryngeal endoscopy plays a determinant role in clinical evaluation of dysphagia. The examination is performed by means of a trans-nasal approach with a flexible fiberoptic endoscope, able to visualize the pre- and post-deglutitory steps of the pharyngeal phase of swallowing. In patients with tracheostomy, it is possible to visualize the glottic or neoglottic function during the intra-deglutitory phase, performing the examination through a trans-tracheostomic route. The procedure and indications of this endoscopic technique are described.

Surgical rehabilitation of dysphagia after partial laryngectomy.

Surgical rehabilitation of dysphagia in patients who have undergone partial laryngectomy is aimed at improving the sphincteric action of the larynx, the anatomy and physiology of which are impaired. The interventions indicated for this purpose can be performed either with an external or endoscopic approach. The Authors present early results of their experience employing injection laryngoplasty with autologous fat, bovine collagen (Zyplast, McGhan Medical Corporation, Fremont, CA, USA) and PDMS (Vox Implants, Uroplasty Inc, Minnetonka, MN, USA), performed by means of fiberendoscopy, under local anaesthesia, and microlaryngoscopy, under general anaesthesia.