Hirano Shigeru
Department of Otolaryngology-Bronchoesophagology, Kyoto Medical Center, Fushimi, Kyoto, Japan.
Curr Opin Otolaryngol Head Neck Surg. 2005 Jun;13(3):143-7. doi: 10.1097/01.moo.0000162261.49739.b7.
Vocal fold scarring still remains a therapeutic challenge, with the most problematic issue being the histologic changes that are primarily responsible for altering the viscoelasticity of the vocal fold mucosa. Optimal treatment for vocal fold scarring has not yet been established. To restore or regenerate damaged vocal folds, it is important to investigate the changes to the layer structure of the lamina propria. Tissue engineering and regenerative medicine may provide new strategies for the prevention and treatment of vocal fold scarring. Recent developments in this field are reviewed in the present article.
Histologic studies have revealed that hyaluronic acid, fibronectin, decorin, and various other extracellular matrix components, as well as collagen, may contribute to determining the vibratory properties of the vocal fold mucosa. Changes of these molecules are thought to affect the viscoelasticity of the scarred vocal folds. Based on such histologic findings, innovative approaches have been developed, including administration of hyaluronic acid into injured or scarred vocal folds. Other strategies that have recently shown advances include growth factor therapy and cell therapy using stem cells or mature fibroblasts. The effects of these new treatments have not fully been confirmed clinically, but there seems to be great therapeutic potential in such regenerative medical strategies.
Recent research has revealed the detailed histologic and rheologic changes related to vocal fold scarring. Based on these findings, various new therapeutic strategies have been developed in animal models using tissue engineering and regenerative medicine. However, no clinical trials have been performed, and more studies are necessary to establish the optimum modality.
声带瘢痕仍然是一个治疗难题，最棘手的问题是组织学变化，这些变化是导致声带黏膜黏弹性改变的主要原因。目前尚未确定声带瘢痕的最佳治疗方法。为了恢复或再生受损的声带，研究固有层的层结构变化非常重要。组织工程和再生医学可能为声带瘢痕的预防和治疗提供新策略。本文综述了该领域的最新进展。
组织学研究表明，透明质酸、纤连蛋白、核心蛋白聚糖以及各种其他细胞外基质成分，还有胶原蛋白，可能有助于决定声带黏膜的振动特性。这些分子的变化被认为会影响瘢痕化声带的黏弹性。基于这些组织学发现，已经开发出了创新方法，包括向受伤或瘢痕化的声带注射透明质酸。最近取得进展的其他策略包括生长因子治疗以及使用干细胞或成熟成纤维细胞的细胞治疗。这些新治疗方法的效果尚未在临床上得到充分证实，但这种再生医学策略似乎具有巨大的治疗潜力。
最近的研究揭示了与声带瘢痕相关的详细组织学和流变学变化。基于这些发现，在动物模型中利用组织工程和再生医学开发了各种新的治疗策略。然而，尚未进行临床试验，需要更多研究来确定最佳治疗方式。
