New insights into the anatomy and physiology of phonation, along with
technological advances in voice assessment and quantification, have le
d to dramatic improvements in medical voice care. Techniques to preven
t vocal fold scar have been among the most important, especially scarr
ing and hoarseness associated with voice surgery. Nevertheless, dyspho
nia due to vocal fold scar is still encountered all too frequently. Al
though it is not generally possible to restore such injured voices to
normal, patients with scar-induced dysphonia can usually be helped. Vo
ice improvement is optimized through a team approach. Treatment may in
clude sophisticated voice therapy and vocal fold surgery. Although exp
erience with collagen injection has been encouraging in selected cases
(particularly in those involving limited areas of vocal fold scar), t
here is no consistently successful surgical technique. Attempts to tre
at massive vocal fold scar, such as may be seen following vocal fold s
tripping, have been particularly unsuccessful. This paper reports prel
iminary experience with the implantation of autologous fat into the vi
bratory margin of the vocal fold of patients with severe, extensive sc
arring. Using this technique, it appears possible to recreate a mucosa
l wave and improve voice quality. Additional research is needed.