Vocal Fold Injection Of Autologous Adipose Through Trans-thyroid Cartilage Approach For The Treatment Of Sulcus Vocalis

Objectives:Injection laryngoplasty is recognized as an effective surgical method for glottic incompetence. This study aims to evaluate short- and long-term outcomes of vocal fold injection(VFI) with autologous adipose through modified trans-thyroid cartilage approach for the patients suffered sulcus vocalis.Methods:Retrospective chart review of 36 patients undergoing VFI was performed from March, 2008 to October, 2014 in the department of Otorhinolaryngology, Jingjia People’s Hosptial. All the patients(25 males and 11 females, age 24-57 years) were examined by strobolaryngoscopy pre- and post-operatively. Twenty-one cases were diagnosed as II type sulcus vocalis and 15 cases were III type sulcus vocalis. Comparison of pre-post objective and subjective voice assessment was evaluated as well as maximum phonatory time(MPT). Perceptual measures included Grade, Roughness, Breathiness, Asthenia, Strain(GBRAS) perceptual rating. Objective measures included jitter, shimmer, noise-to-harmonic ratio(NHR) and MPT. All the cases were followed up 6 and 12 months postoperatively. Statistical differences between pre- and postoperative perceptual evaluation, acoustic analysis, and MPT data were analyzed by using the Wilcoxon signed rank test. Statistical analyses were conducted using the SPSS software.Results:All cases with sulcus vocalis presented with persistent hoarseness and fatigue with pronunciation. The longitudinal groove-shaped depression in free edge portion of the ipsilateral vocal cord, the weakened mucosal spread and amplitude and the fissures of glottis when closed pronunciation can be observed by dynamic laryngoscope. All cases of II type and most cases of III type regained a significant improvement of vocal quality, a better glottal closure, an enhancement of mucosal wave excursion after VFI. Perceptual assessments by GRBAS scale significantly improved at 6 and 12 months after VFI(p < 0.05). Although the voice quality did not achieve the normal level, the patients exhibited a better voice, with improved fundamental frequency, jitter, shimmer, normalized noise energy, and a significantly longer maximum phonation time(p < 0.05). No major complications were observed in these cases.Conclusions:Vocal fold injection with autologous adipose through trans-thyroid cartilage approach avoids scarring in the form and layer of vocal cord and leakage of autologous adipose. It successfully improves the voice quality of the patients with sulcus vocalis for one year. It is a safe and effective surgical intervention for sulcus vocalis.