Ricci Maccarini A, Stacchini M, Mozzanica F, Schindler A, Basile E, DE Rossi G, Woo P, Remacle M, Magnani M
ENT Department, M. Bufalini Hospital, Cesena, Italy.
Department of Biomedical and Clinical Sciences, L. Sacco Hospital, University of Milan, Milan, Italy.
Acta Otorhinolaryngol Ital. 2018 Jun;38(3):204-213. doi: 10.14639/0392-100X-2012.
The objective of this work is to evaluate the safety, feasibility and efficacy of trans-nasal fiberendoscopic injection laryngoplasty (IL) with centrifuged autologous fat, performed under local anaesthesia, in the treatment of glottic insufficiency due to unilateral vocal fold paralysis (UVFP). It is a within-subject study with follow-up 1 week after phonosurgery and after 6 months. A total of 22 patients with chronic dysphonia caused by glottic insufficiency due to UVFP were enrolled. Each patient underwent trans-nasal IL with centrifuged autologous fat through flexible operative endoscope under local anaesthesia and was evaluated before and twice (1 week and 6 months) after phonosurgery, using a multidimensional set of investigations. The assessment protocol included videolaryngostroboscopy, perceptual evaluation of dysphonia, maximum phonation time and patient's self-assessment on voice-related quality of life (QOL) with the Voice Handicap Index-10 and the comparative self-assessment on vocal fatigue and voice quality pre-post treatment. Trans-nasal IL with centrifuged autologous fat was performed in all 22 patients and there were no complications in any case. Significant improvements in videolaryngostroboscopic findings, perceptual evaluation of dysphonia, maximum phonation time and QoL self-assessment were reported after 1 week and were maintained at 6 months. In one patient, the result after 6 months was not satisfactory and this patient then underwent a medialization laryngoplasty (thyroplasty type I) with satisfactory long-term results. In conclusion, trans-nasal fiberendoscopic IL with centrifuged autologous fat seems to be a safe, feasible and efficacious phonosurgical procedure for treatment of glottic insufficiency due to unilateral vocal fold paralysis.
本研究旨在评估在局部麻醉下经鼻纤维内镜注射离心自体脂肪喉成形术（IL）治疗单侧声带麻痹（UVFP）所致声门闭合不全的安全性、可行性和有效性。这是一项受试者自身前后对照研究，在嗓音手术后1周和6个月进行随访。共有22例因UVFP导致声门闭合不全而患有慢性发声困难的患者入组。每位患者在局部麻醉下通过可弯曲手术内镜接受经鼻离心自体脂肪IL治疗，并在嗓音手术前以及术后两次（1周和6个月）进行评估。评估方案包括视频喉镜频闪检查、发声困难的主观评估、最长发声时间，以及患者使用嗓音障碍指数-10对与嗓音相关的生活质量（QOL）进行自我评估，同时对治疗前后的嗓音疲劳和嗓音质量进行自我比较评估。所有22例患者均接受了经鼻离心自体脂肪IL治疗，无一例出现并发症。术后1周时，视频喉镜频闪检查结果、发声困难的主观评估、最长发声时间和QOL自我评估均有显著改善，并在术后6个月时保持稳定。有1例患者术后6个月效果不满意，随后接受了I型甲状成形术的喉内移术，长期效果良好。总之，经鼻纤维内镜离心自体脂肪IL似乎是一种安全、可行且有效的嗓音外科手术，可用于治疗单侧声带麻痹所致的声门闭合不全。
