Comparative Analysis of Efficiency of Injection Laryngoplasty Technique for with or without Neck Treatment Patients: A Transcartilaginous Approach Versus the Cricothyroid Approach

이승원,김재욱,고윤우,심성신,손영익 대한이비인후과학회 2010 Clinical and Experimental Otorhinolaryngology Vol.3 No.1

Objectives. These days, the main injection laryngoplasty technique is cricothyroid (CT) approach. However, patients who have previously undergone other neck treatments, such as thyroidectomy or neck dissection have distorted anatomical landmark makes this approach more difficult. The aim of this study is to determined the efficiency of transcartilaginous (TC) approah as compared with CT approach for unilateral vocal fold paralysis patients, especially for previously neck treated patients. Methods. From March 2005 to February 2008, 137 consecutive injection laryngoplasties were performed in patients with unilateral glottic insufficiency. Percutaneous injection was performed under local anesthesia into the vocalis muscle, using disposable 25 G 4 cm long needles through the cricothyroid membrane or directly through the thyroid cartilage. Of the 137 patients, 124 completed acoustic, perceptual, stroboscopic, and subjective evaluations prior to the injection and at 3 months after the injection. Results. In the 124 patients, the CT and TC approaches were used in 94 and 30 patients, respectively. Acoustic and perceptual parameters (GRBAS, MPT, jitter, shimmer), voice handicap index, and grades of mucosal waves and glottic closure were significantly improved after the injection in both the CT and TC groups (P<0.05). Only two patients (6.6%) had penetration difficulties, because of ossification of the thyroid cartilage. The overall success rates of the CT and TC approaches were 86.2%, 93.3%, respectively. However, the success rate of the TC approach in patients who had previously undergone neck treatments was significantly higher than that of the CT approach (100% vs. 65% P<0.05). Conclusion. Based on the preliminary results of this trial, injection laryngoplasty using a TC approach was an effective alternative to the CT approach, especially in patients who had previously undergone neck surgeries.

Autologous Platelet-Poor Plasma Gel for Injection Laryngoplasty

우승훈,김진평,박정제,정필상,이상혁,정한신 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.6

Purpose: To overcome the potential disadvantages of the use of foreign materials and autologous fat or collagen, we introduce here an autologous plasma gel for injection laryngoplasty. The purpose of this study was to present a new injection material, a plasma gel, and to discuss its clinical effectiveness. Materials and Methods: From 2 mL of blood, the platelet poor serum layer was collected and heated at 100°C for 12 min to form a plasma gel. The plasma gel was then injected into a targeted site; the safety and efficacy thereof were evaluated in 30 rats. We also conducted a phase I/II clinical study of plasma gel injection laryngoplasty in 11 unilateral vocal fold paralysis patients. Results: The plasma gel was semi-solid and an easily injectable material. Of note, plasma gel maintains the same consistency for up to 1 year in a sealed bottle. However, exposure to room air causes the plasma gel to disappear within 1 month. In our animal study, the autologous plasma gel remained in situ for 6 months in animals with minimal inflammation. Clinical study showed that vocal cord palsy was well compensated for with the plasma gel in all patients at two months after injection with no significant complications. Jitter, shimmer, maximum, maximum phonation time (MPT) and mean voice handicap index (VHI) also improved significantly after plasma gel injection. However, because the injected plasma gel was gradually absorbed, 6 patients needed another injection, while the gel remained in place in 2 patients. Conclusion: Injection laryngoplasty with autologous plasma gel may be a useful and safe treatment option for temporary vocal cord palsy.

Artecollⓡ Restylaneⓡ 성대내 주입술 후 조직학적 변화 및성대점막 진동 양상:생체 동물 실험

임재열,김한수,김영호,권순호,장정헌,이윤재,김현경,최홍식 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.6

Background and Objectives:The aims of this study are to introduce Artecoll and Restaylane, that have been available for facialaugmentation, as new materials for injection laryngoplasty, to investigate the mucosal wave of true vocal folds after the injectionof these two materials into the true vocal fold, and to assess its biocompatibility and durability. Subjects and Method:Aftercomplete paralysisof the right recurrent laryngeal nerve of 6 Beagle dogs, the dogs were divided into the Artecoll injection groupand the Restylane injection group, and Artecoll or Restylane was injected into vocalis muscle and vocal ligament. The recurrentlaryngeal nerve of the opposite side was stimulated, the posterior commissure was sutured, and the mucosal wave of true vocalfolds was examined by stroboscopy in in vivo canine study 1, 3, and 6 months after the injection. And, histopathological changeof the injected materials after total laryngectomy wasexamined by hematoxylin and eosin (H & E) staining and masson trichromestaining. Results:In both the Artecoll injection and the Restylane injection groups, the mucosal wave of true vocal folds wasdetected by stroboscopic examination until 6 months after the injection, and the difference of the mucosal wave of true vocal foldsbetween these two groups was difficult to detect. Histological studies revealed that the injected materials remained in the vocalligament and vocalis muscle and theses two materials were resorbed with time, Artecoll showing less resorption. These twomaterials were biocompatible and, particularly, Restylane showed less foreign body reaction. Conclusion:Since both Artecolland Restylane are biocompatible and durable, they areconsidered as the suitable material for injection larygoplasty, and additionallong-term studies are required.

두 가지 Calcium Hydroxylapatite(Radiesse versus Facetem)를 이용한 Injection Laryngoplasty의 단기 음성 결과의 비교연구

이현호,박성준,박영학 대한이비인후과학회 2019 대한이비인후과학회지 두경부외과학 Vol.62 No.10

Background and Objectives Radiesse® is a widely used calcium hydroxyapatite (CaHA)injection material used for vocal fold injection. Recently, a new CaHA injection material (Facetem®) which complements the structural disadvantages of Radiesse has been developed andreleased in the market. The aim of this study is to compare the efficacy and short-term voiceoutcome of these two CaHA materials. Subjects and Method A retrospective analysis was performed for 70 patients with unilateralvocal fold paralysis who underwent vocal fold injection using CaHA materials. Acousticvoice analysis, maximal phonation time (MPT), voice handicap index (VHI), and Grade,Roughness, Breathiness, Asthenia, Strain (GRBAS) scale were evaluated between Radiesseand Facetem injection group. Results Both groups showed a signifcant improvement of MPT, VHI, and G, B, A scale afterinjection. The Facetem group showed similar voice improvement as the Radiesse group,where pre- and postoperatively objective and subjective voice evaluation results were compared. Conclusion Our study reveals that there is no significant difference in efficacy and nor anyshort-term vocal improvement between Radiesse and Facetem. Therefore, the use of Facetem asCaHA injection material could be considered as an alternative material for patients with unilateralvocal cord paralysis.

일측성 성대마비 환자에 대한 치료방법 비교

이창윤(Chang Yoon Lee),손희영(Hee Young Son),권순복(Sun Bok Kwon) 한국언어치료학회 2016 한국언어치료학회 학술발표대회 논문집 Vol.2016 No.12

Purpose: The purpose of this study was to analysis the effects of two treatment methods on patients with unilateral vocal fold paralysis by voice therapy and injection laryngoplasty. Methods: Twenty patients were treated injection laryngoplasy and 23 patients were treated voice therapy. results were evaluated by acoustic analysis, electro glotto graphy(EGG), cepstrum analysis before and after therapy. The therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic and use the breathing. Results: Significant improvement was found in the acoustic parameter, cepstrum parameter, and EGG before and after treatment in both groups. There was no significant difference between the two groups when compared before and after treatment to compare the effects of injection laryngoplasty and voice therapy. Conclusions: The initial treatments for unilateral vocal cord paralysis are injection laryngoplasty and voice therapy. Injection laryngoplasty is commonly used in clinical settings, and studies on the effects of voice therapy on patients with vocal fold paralysis are lacking. In particular, the voice therapy method used in this study was to apply the holistic voice therapy method to increase the mobility of the vocal cords while simultaneously eliminating secondary compensation due to vocal fold paralysis and to use breathing together. The results of this study suggest that voice therapy in addition to Injection laryngoplasty at the initial stage is a very useful method to improve voice quality of vocal fold paralysis and improve laryngeal function.

Calcium Hydroxylapatite Pulmonary Embolism after Percutaneous Injection Laryngoplasty

원성준,우승훈 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.6

Injection medialization laryngoplasty is a procedure that has many advantages in treating vocal fold paralysis; however, undesiredcomplications can occur. We experienced a case of a pulmonary embolism, suspected in a patient who had undergone an injection laryngoplasty with calcium hydroxylapatite (CaHA). The patient suffered dyspnea after undergoing the injection laryngoplasty. Chest embolism computed tomography (CT) scan revealed a new lesion of enhancing materials at the pulmonary vasculaturein the right upper lobe. The CaHA embolism was suspected, and the patient was treated with warfarin for 12 months. The patient’s symptom of dyspnea nearly disappeared and a follow up chest embolism CT scan revealed no signs of the previous lesion. Thus, we would like to report this rare case along with a review of the literature.

흡인을 동반한 일측성 성대마비 환자에서 일시적 성대주입술의 역할

장현,안영진,임윤성,하정훈,성명훈,김광현,권택균 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.3

Background and Objectives:We evaluated the role of temporary injection laryngoplasty in patients with unilateral vocal fold paralysis (UVFP) after cardiothoracic surgeries. Subjects and Method:Taking the introduction of injection laryngoplasty as a milestone, we divided patients into those who underwent cardiothoracic surgery with UVFP during the years 2001-2004, before the introduction of injection laryngoplasty as pre-injection group (n=83) and those who underwent after the introduction during the years 2000-2007 as post-injection group (n=103). Of the post injection group, patients who received injection laryngoplasty postoperatively before being discharged were defined as injection group (n=37). Patients were also divided into non-esophageal surgery group and esophageal surgery group. Clinical outcomes including the length of hospital stay and oral feeding initiation time were compared between the pre-injection group and the injection group within the same operation group. The degrees of aspiration were classified into 4 grades. Results:In the non-esophageal surgery group, the injection group with aspiration grade III had shorter hospital stay and oral feeding initiation time after extubation compared to the pre-injection group with grade III aspiration (p=0.042). However, in the esophageal surgery group, there was no statistical difference between the pre-injection and injection groups. Conclusion:Temporary injection laryngoplasty can reduce the hospital stay and enhance oral feeding initiation in patients with aspiration due to UVFP after non-esophageal cardiothoracic surgeries.

Injectable basic fibroblast growth factor-loaded alginate/hyaluronic acid hydrogel for rejuvenation of geriatric larynx

Choi, Young Hwan,Kim, Sae Hyun,Kim, In Gul,Lee, Jin Ho,Kwon, Seong Keun Elsevier Science B.V. Amsterdam 2019 ACTA BIOMATERIALIA Vol. No.

<P><B>Abstract</B></P> <P>Increase in the geriatric population has led to an increase in the number of elderly patients with laryngeal atrophy and dysfunction. Symptoms of voice change, dysphagia, and aspiration pneumonia negatively influence patient’s health status, quality of life, and life span. Injection laryngoplasty used to treat laryngeal dysfunctions does not recover intrinsic functions of the larynx. Thus, we fabricated an injectable basic fibroblast growth factor (bFGF)-loaded alginate (ALG)/hyaluronic acid (HA) hydrogel for inducing rejuvenation of geriatric laryngeal muscles. Optimal <I>in situ</I>-forming bFGF–loaded ALG/HA hydrogel for injection laryngoplasty was prepared and the release profile of bFGF was analyzed. For <I>in vivo</I> analysis, the bFGF–loaded ALG/HA hydrogel was injected into the laryngeal muscles of 18-month-old Sprague-Dawley rats. The rejuvenation efficacy of bFGF–loaded ALG/HA hydrogel in geriatric laryngeal muscle tissues 4- and 12-weeks post-injection was evaluated by quantitative polymerase chain reaction (qPCR), histology, immune-fluorescence staining and functionality analysis. The bFGF-loaded ALG/HA hydrogel induced an increase in the expression of myogenic regulatory factor-related genes, hypertrophy of muscle fiber, proliferation of muscle satellite cells, and angiogenesis and decreased interstitial fibrosis. Administration of the bFGF-loaded ALG/HA hydrogel caused successful glottal gap closure. Thus, the bFGF-loaded ALG/HA hydrogel could be a promising candidate for laryngoplasty aimed at rejuvenating geriatric larynx.</P> <P><B>Statement of Significance</B></P> <P>In this manuscript, optimal <I>in situ</I>-forming bFGF–loaded ALG/HA hydrogel for injection laryngoplasty was prepared and the release profile of bFGF was analyzed. Herein, we introduced the materials and methods of injection laryngoplasty for geriatric rat experiment. In addition, we studied effects of bFGF-loaded ALG/HA hydrogel on the therapeutic rejuvenation of geriatric rat larynx. The bFGF-loaded ALG/HA hydrogel induced an increase in the expression of myogenic regulatory factor-related genes, hypertrophy of muscle fiber, proliferation of muscle satellite cells, and angiogenesis and decreased interstitial fibrosis. Furthermore, our functional analysis through the high-speed camera setup demonstrated that the administration of the bFGF-loaded ALG/HA hydrogel induced successful glottal gap closure. Thus, the bFGF-loaded ALG/HA hydrogel could be a promising candidate for injection laryngoplasty with therapeutic effects.</P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Injection laryngoplasty of human adipose-derived stem cell spheroids with hyaluronic acid-based hydrogel improves the morphological and functional characteristics of geriatric larynx

이도영,Young Hwan Choi,최지숙,Min Rye Eom,권성근 한국생체재료학회 2022 생체재료학회지 Vol.26 No.2

Aim: As the geriatric population increased, the need of treatment for laryngeal atrophy and dysfunction increased. This study was performed to evaluate the effects of injection of human adipose-derived stem cell (hASC) spheroidloaded catechol-conjugated hyaluronic acid (HA-CA) hydrogel on therapeutic rejuvenation of the geriatric larynx. Methods: Stem cell spheroids with hyaluronic acid-based hydrogel were injected into the laryngeal muscles of 18-month-old Sprague–Dawley rats. The effects of hASC spheroids were examined in the following four groups: SHAM, injected with PBS; GEL, injected with HA-CA hydrogel; MONO, injected with single hASCs in HA-CA hydrogel; and SP, injected with hASCs spheroids in HA-CA hydrogel. The rejuvenation efficacy in geriatric laryngeal muscle tissues at 12 weeks postinjection was evaluated and compared by histology, immunofluorescence staining, and functionality analysis. Results: Total myofiber cross-sectional area and myofiber number/density, evaluated by detection of myosin heavy chain with antibodies against laminin and fast myosin heavy chain, were significantly higher in the SP group than in the other groups. The lamina propria of the larynx was evaluated by alcian blue staining, which showed that the HA was increased significantly in the SP group compared to the other groups. In functional analysis, the glottal gap area was significantly reduced in the SP group compared to the other groups. The phase difference in the vocal fold during vibration was also smaller in the SP group than in the other groups, but the difference did not reach statistical significance. Conclusion: Injection of hASC spheroids with hyaluronic acid-based hydrogel improves the morphological and functional characteristics of geriatric larynx.

레인케 공간에 주입된 히알루론산의 수술적 제거 1예

오정호,박찬우,김성원,이강대 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.12

Injection laryngoplasty is a simple and noninvasive method for treating unilateral vocal cord paralysis. Lately hyaluronic acid is widely used as injection material, because it is spontaneously resolved after few months and can be injected superficially compared to other materials. However, if hyaluronic acid is injected in the superficial layer of lamina propria (Reinke’s space), it can cause inflammation or granuloma, interrupt the vibration of the vocal cord and worsen the quality of voice. We here present a case of granuloma that occurred as a complication of injection laryngoplasty, where simple surgical method was employed to improve voice quality. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:782-6