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Allograft (Alloderm) and autograft (temporalis fascia) implantation for glottic insufficiency: a novel approach.
J Voice. 2011 Sep; 25(5):619-25.JV

Abstract

OBJECTIVE

Traditionally, glottic insufficiency because of scar, atrophy, and sulcus has been treated by injection or medialization laryngoplasty. These procedures do not reestablish the vertical height of the vocal fold margin. We propose soft tissue augmentation laryngoplasty with allograft (sheet Alloderm; LifeCell Corporation, Branchburg, NJ) or autograft (temporalis fascia) via a minithyrotomy or a transoral approach.

STUDY DESIGN

A retrospective case series analysis of 21 patients treated by sheet Alloderm or temporalis fascia for correction of glottic insufficiency.

METHODS

Twenty-one patients with glottic insufficiency secondary to scar, atrophy, or sulcus were treated. Ten failed prior techniques. Seventeen had minithyrotomy by a small fenestration in the thyroid cartilage. Exploration of scar or lamina propria through the fenestration allowed for the creation of a pocket for Alloderm implantation within the intermediate layer of the lamina propria. Four patients underwent a transoral approach by cordotomy with either Alloderm or temporalis fascia implantation, which also allowed for exploration of scar but required repair using sutures. These implantation approaches allowed for both restoration of the layered structure and augmentation of the middle third of the musculomembranous vocal fold. Preoperative and postoperative videostroboscopic examinations were reviewed with review of clinical outcome.

RESULTS

With a median follow-up time of 12 months, patients demonstrated excellent long-term vocal fold augmentation and minimal absorption of the implant in 19 out of 21 patients. There is improved pliability of the vocal fold with good oscillation in scar patients.

CONCLUSION

Minithyrotomy with soft tissue augmentation is a novel approach for soft tissue augmentation of glottic insufficiency. It has the advantage of augmentation of the medial edge of the vocal fold with a soft tissue implant that has long-term viability. Its role should be explored further in patients with atrophy and scar.

Authors+Show Affiliations

The Department of Otolaryngology Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA. melintangeller@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21051201

Citation

Tan, Melin, et al. "Allograft (Alloderm) and Autograft (temporalis Fascia) Implantation for Glottic Insufficiency: a Novel Approach." Journal of Voice : Official Journal of the Voice Foundation, vol. 25, no. 5, 2011, pp. 619-25.
Tan M, Bassiri-Tehrani M, Woo P. Allograft (Alloderm) and autograft (temporalis fascia) implantation for glottic insufficiency: a novel approach. J Voice. 2011;25(5):619-25.
Tan, M., Bassiri-Tehrani, M., & Woo, P. (2011). Allograft (Alloderm) and autograft (temporalis fascia) implantation for glottic insufficiency: a novel approach. Journal of Voice : Official Journal of the Voice Foundation, 25(5), 619-25. https://doi.org/10.1016/j.jvoice.2010.08.001
Tan M, Bassiri-Tehrani M, Woo P. Allograft (Alloderm) and Autograft (temporalis Fascia) Implantation for Glottic Insufficiency: a Novel Approach. J Voice. 2011;25(5):619-25. PubMed PMID: 21051201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Allograft (Alloderm) and autograft (temporalis fascia) implantation for glottic insufficiency: a novel approach. AU - Tan,Melin, AU - Bassiri-Tehrani,Michael, AU - Woo,Peak, Y1 - 2010/11/04/ PY - 2010/06/18/received PY - 2010/08/05/accepted PY - 2010/11/6/entrez PY - 2010/11/6/pubmed PY - 2012/1/6/medline SP - 619 EP - 25 JF - Journal of voice : official journal of the Voice Foundation JO - J Voice VL - 25 IS - 5 N2 - OBJECTIVE: Traditionally, glottic insufficiency because of scar, atrophy, and sulcus has been treated by injection or medialization laryngoplasty. These procedures do not reestablish the vertical height of the vocal fold margin. We propose soft tissue augmentation laryngoplasty with allograft (sheet Alloderm; LifeCell Corporation, Branchburg, NJ) or autograft (temporalis fascia) via a minithyrotomy or a transoral approach. STUDY DESIGN: A retrospective case series analysis of 21 patients treated by sheet Alloderm or temporalis fascia for correction of glottic insufficiency. METHODS: Twenty-one patients with glottic insufficiency secondary to scar, atrophy, or sulcus were treated. Ten failed prior techniques. Seventeen had minithyrotomy by a small fenestration in the thyroid cartilage. Exploration of scar or lamina propria through the fenestration allowed for the creation of a pocket for Alloderm implantation within the intermediate layer of the lamina propria. Four patients underwent a transoral approach by cordotomy with either Alloderm or temporalis fascia implantation, which also allowed for exploration of scar but required repair using sutures. These implantation approaches allowed for both restoration of the layered structure and augmentation of the middle third of the musculomembranous vocal fold. Preoperative and postoperative videostroboscopic examinations were reviewed with review of clinical outcome. RESULTS: With a median follow-up time of 12 months, patients demonstrated excellent long-term vocal fold augmentation and minimal absorption of the implant in 19 out of 21 patients. There is improved pliability of the vocal fold with good oscillation in scar patients. CONCLUSION: Minithyrotomy with soft tissue augmentation is a novel approach for soft tissue augmentation of glottic insufficiency. It has the advantage of augmentation of the medial edge of the vocal fold with a soft tissue implant that has long-term viability. Its role should be explored further in patients with atrophy and scar. SN - 1873-4588 UR - https://www.unboundmedicine.com/medline/citation/21051201/Allograft__Alloderm__and_autograft__temporalis_fascia__implantation_for_glottic_insufficiency:_a_novel_approach_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0892-1997(10)00150-5 DB - PRIME DP - Unbound Medicine ER -