Histologic comparison of vocal fold microflap healing with sutures and glue

Improved voice quality is the expected outcome of microphonosurgery. To this end, the complex vibratory movement of the vocal folds must be preserved. Scarring of the vocal folds may compromise vocal outcome and is one of the most difficult to treat conditions. To minimize scar formation, a consensus exists on the need for maximum preservation of the epithelium and superficial lamina propria, and minimal exposure of vocal ligament. However, the need to cover the microflap defect is controversial. The aim of this study was to compare healing characteristics of microflap technique when the microflap is left to heal by second intention, when the defect is closed with sutures, and when it is covered with glue.

Experimental animal study.

An experimental study comparing the three techniques was carried out on 37 New Zealand rabbits. Vocal fold healing was evaluated 7, 30, and 90 days after surgical intervention. Collagen concentration, inflammatory reaction, epithelium, and lamina propria thickness were evaluated.

Collagen concentration significantly increased in all groups. After 7 days, epithelium thickness significantly increased and lamina propria thickness was not significantly altered. At 90 days, only the suture group showed no significant alteration in epithelium thickness. After 90 days, lamina propria thickness decreased, except in the fibrin glue group. No difference was seen in the number of inflammatory cells among the techniques.

The use of microsutures or fibrin glue to close microflap defects did not consistently improve vocal fold healing nor produce better scarring results when compared to healing by second intention.