Abstract
Various implant materials have been used to treat glottic insufficiency by means of intracordal injection. So far, autologous fat is the most commonly used. Homologous collagen is a new injectable acellular graft material. This collagen, made of 200-μ particles, is delivered as a freeze-dried powder in a 1-cc-unit syringe and is rehydrated with standard saline solution prior to injection. A prospective study was conducted on 23 patients with unilateral vocal fold paralysis. All injections were performed under general anesthesia using the collagen injection system and a 25-gauge needle. A mean quantity of 1.05 ml (SD: 0.41) of collagen was injected as much as possible in the deep part of the lamina propria. Voicing was resumed after 2 days. The mean follow-up was of 8 months (range: 2–18). Functional results were measured according to the ELS protocol. G(rade), R(oughness) and B(reathiness) according to Hirano were reported on a four-point grading scale showing an improvement from 2.13 to 1.13 for G (P<0.001), from 1.50 to 0.82 for R (P<0.002) and from 1.73 to 1.05 for B (P<0.001). The parameters selected for videolaryngostroboscopy, G(lottal) (Clo)sure, (R)egularity, (M)ucosal (W)ave and (Sym)metry, were measured on a visual analog scale. They showed an improvement from 23 to 19 for Clo (P=0.087), from 15 to 6 for R (P=0.001), from 15 to 11 for MW (P=0.039) and from 17 to 8 for Sym (P=0.001). For the aerodynamic parameters, the maximum phonation time (MPT) and the phonation quotient (PQ) showed an improvement from 5.8 to 8.9 s (P=0.002) and from 704.5 to 449.7 ml/s (P=0.004), respectively. The acoustic parameters were improved from 5.3 to 3.6 (P=0.045) for the jitter (%), they didn’t change for the shimmer [(%): 2.4], and they were improved non-significantly from 187.9 to 218.7 Hg for the frequency range. The lowest level intensity was non-significantly increased from 49.6 to 51.3 dB. Regarding the subjective evaluation, the Voice Handicap Index (VHI) was improved from 65 to 37. To date, no homologous collagen-related morbidity has been observed. Injectable homologous collagen appears to be safe and suitable for injection laryngoplasty. Long-term results are pending.
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References
Arnold GE, Stephens CB (1980) Laryngeal injections with polytef paste. Ear Nose Throat J 59:415–418
Brunings W (1911) Ueber eine neue behandlungsmethode der Rekkurenslähmung. Verhandl Ver Deutsh Laryngol 18:93–151
Courey MS (2001) Homologous collagen substances for vocal fold augmentation. Laryngoscope 111:747–758
Dejonckere Ph, Bradley P, Clemente P, Cornut G, Crevier-Buchman G, Friedrich G, Van de Heyning P, Remacle M, Woisard V (2001) A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of phonosurgical treatments and evaluating new assessment techniques. Eur Arch Othorhinolaryngol 258:77–82
Ford CN, Martin DW, Warner TF (1984) Injectable collagen in laryngeal rehabilitation. Laryngoscope 94:513–518
Ford CN, Bless DM (1986) Clinical experience with injectable collagen for vocal fold augmentation. Laryngoscope 96:863–869
Ford CN, Bless DM, Loftus JM (1992) Role of injectable collagen in the treatment of glottic insufficiency: a study of 119 patients. Ann Otol Rhinol Laryngol 101:237–247
Ford CN, Staskowski PA, Bless DM (1995) Autologous collagen vocal fold injection: a preliminary clinical study. Laryngoscope 105:944–948
Hirano M, Mori K, Tanaka S, Fujita M (1995) Vocal function in patients with unilateral vocal fold paralysis before and after silicone injection. Acta Otolaryngol 115:553–559
Pearl A, Woo P, Ostrowski R, Mojica J, Mandell DL, Costantino P (2002) A preliminary report on micronized Allderm injection laryngoplasty. Laryngoscope 112:990–996
Remacle M, Millet B, van Heule P, Duvivier D (1989) Clinical application of the high-resolution frequency analyzer. First results. Folia Phoniatr.Basel 41:259–269
Remacle M, Marbaix E, Hamoir M, Bertrand B, Van den Eeckhaut J (1990) Correction of glottic insufficiency by collagen injection. Ann Otol Rhinol Laryngol 99:438–444
Remacle M, Dujardin JM, Lawson G (1995) Treatment of vocal fold immobility by glutaraldehyde-cross-linked collagen injection: long-term results. Ann Otol Rhinol Laryngol 104:437–441
Remacle M, Lawson G, Delos M, Jamart J (1999) Correcting vocal fold immobility by autologous collagen injection for voice rehabilitation. A short-term study. Ann Otol Rhinol Laryngol 108:788–793
Remacle M, Lawson G, Keghian J, Jamart J (1999) Use of injectable autologous collagen for correcting glottic gaps: initial results. J Voice 13:280–288
Rihkanen H (1998) Vocal fold augmentation by injection of autologous fascia. Laryngoscope 108:51–54
Rihkanen H, Reijonen P, Lehikoinen-Soderlund S, Lauri ER (2004). Videostroboscopic assessment of unilateral vocal fold paralysis after augmentation with autologous fascia. Eur Arch Otorhinolaryngol 261:177–183
Rosen CA (2000) Phonosurgical vocal fold injection: procedures and materials. Otolaryngol Clin North Am 33:1087–1096
Rosen C, Thekdi A (2004) Vocal fold augmentation with injectable calcium hydroxylapatite: short-term results. J Voice 18:387–391
Shaw GY, Szewczyk MA, Searle J, Woodroof J (1997) Autologous fat injection into the vocal folds: technical considerations and long-term follow-up. Laryngoscope 107:177–186
Sittel C, Thumfart WF, Pototschnig C, Wittekindt C, Eckel HE (2000) Textured polydimethylsiloxane elastomers in the human larynx: safety and efficiency of use. J Biomed Mater Res 53:646–650
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Remacle, M., Lawson, G., Jamart, J. et al. Treatment of vocal fold immobility by injectable homologous collagen: short-term results. Eur Arch Otorhinolaryngol 263, 205–209 (2006). https://doi.org/10.1007/s00405-005-0996-0
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DOI: https://doi.org/10.1007/s00405-005-0996-0