Autogenous fat intracordal injection as treatment for unilateral vocal palsy

Intracordal injection, which is less time-consuming and avoids neck incision, remains an important method to correct glottic insufficiency induced by unilateral vocal palsy. Among the various new materials proposed for intracordal injection, autogenous fat draws our attention for its availability without cost and high bio-compatibility. This article reports our preliminary experiences of intracordal injection using autogenous fat to treat glottic insufficiency induced by unilateral vocal palsy.

Autogenous fat is collected under local anesthesia by syringe aspiration from femoral or lower abdomen. Precautions to reduce resorption are taken while collecting and processing the fat. Under the guidance of flexible laryngovideostroboscopy, Bruning syringe with a bended needle is inserted transorally to make the intracordal injection. Serial pre-operation and postoperation evaluations by flexible laryngovideostroboscopy, the patient's selfassessment on the voice, the speech pathologist's perceptual ratings on the breathiness and roughness of the patient's voice, maximum phonation time, and mean airflow rate are made.

A total of 19 cases were recruited for the treatment, and 17 of them completed the procedure. The clinical applicability was 89.5%. The fat injection had no obvious effect on the posterior glottic gap correction. The postoperative glottic gap estimated by the videostroboscopy, was improved in 15 of the 16 cases two weeks after operation, and in five of the seven cases who has been followed up for three months. Twelve of the 16 cases felt improved voice in two postoperative weeks, and six of the seven cases still felt the improvement three months after operation. The rate and amount of resorption varied greatly among individuals. None of the injected cords showed untoward morphological or vibratory changes up to three months after injection.

Intracordal injection of autogenous fat to treat unilateral vocal palsy by the method we propose is relatively simple with high clinical applicability and no extra-cost. None of the injected cords showed unfavorable changes. Most of the patients were improved after injection, at least for a short period of time. The long-term effectiveness remains to be observed. Repetition of the injection is also simple, if the voice results deteriorate due to resorption of the injected fat.