Fascia augmentation of the vocal fold: Graft yield in the canine and preliminary clinical experience

Introduction: Glottal insufficiency resulting from vocal fold bowing, hypom obility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia l ata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance . Study Design: A prospective trial of autologous fascia augmentation of th e vocal cord in the human and in an animal model. Methods: Autologous fasci a injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft y ield from AFIA with autologous fat yield. The outcome measure was graft yie ld calculated from histological examination of larynges 12 weeks after inje ction augmentation. Clinical trial outcome measures included symptom survey s, acoustical voice analyses, and subjective voice assessments. Mean follow -up was 9 months. Results: In the canine larynx, the mean;graft yield for A FIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; ra nge, 7%-96%; P = .57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative v oice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P < .0001). Acoustical p arameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P < .05) in all patients after fas cia augmentation. Conclusions: Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. F ascia appears to be an excellent alternative to Lipoinjection in properly s elected cases of glottic insufficiency.