Management of vocal fold scar with autologous fat implantation: Perceptualresults

Vocal fold scar disrupts the mucosal wave and interferes with glottic closu re. Treatment involves a multidisciplinary approach that includes voice the rapy, medical management, and sometimes surgery. We reviewed the records of the first right patients who underwent autologous fat implantation for voc al fold scar. Information on the etiology of scar, physical findings, and p rior interventions were collected. Videotapes of videostroboscupic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Str ain (GRBAS)] were randomized and analyzed independently by four blinded obs ervers. Etiology of scar included mass excision (7), vocal fold stripping ( 3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures pe rformed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (7,). Strobovideolaryngoscopy : Statistic ally significant improvement was found in glottic closure, mucosal wave, an d stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significa nt improvement was found in all five parameters, including overall Grade, R oughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an importan t adjunctive procedure in the management of vocal fold scar, and a useful a ddition to the armamentarium of the experienced phonomicrosurgeon.