Autogenous fat injection for vocal fold atrophy

Autogenous fat augmentation for glottic insufficiency has been used previously in patient treatment regimes. However, relatively little information is currently available regarding the effectiveness of fat injection for patients with vocal fold atrophy who have complete glottal closure (VFACGC). This paper compares, in retrospect, the efficiency of fat injection after surgery in patients with VFACGC (n=21). The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after fat augmentation was performed on 13 patients. Mean follow-up time was 9.5 months. Fifteen patients displayed excellent results, four experienced post-procedure failure, and two were unavailable for follow-up analysis. The majority of VFACGC patients (71%) also suffered from muscular tension dysphonia (MTD) preoperatively. The procedure also resolved the MTD in half (54%) of the patients in this study. Perceptual rating showed significant improvement in grade, roughness and breathiness (P<0.05). The videolaryngostroboscopic rating showed significant improvements in vocal fold edge linearity (P<0.01), vocal fold vibration amplitude and mucosal wave excursion (P<0.05). VFACGC is commonly misdiagnosed as MTD and is, therefore, unresponsive to speech therapy that is targeted to the latter. Fat injection is an effective autogenous implant and should be considered as an option in the treatment of patients with VFACGC. Although fat re-absorption was identified as a problem, repeating the procedure could be considered to minimize the effect of such.