Autologous Fat Plus Platelet-Rich Plasma versus Autologous Fat Alone on Sulcus Vocalis.

Yung-An Tsou,Wen-Dien Chang,Chien-Jen Chiu,Sheng-Hwa Chen,Vincent Hui-Chi Tien,Tzu-Chieh Lin,Liang-Chun Shih

doi:10.3390/jcm11030725

Abstract

Sulcus vocalis is a frequent cause of glottic insufficiency that leads to incomplete vocal fold closure during phonation. Type II sulcus vocalis is defined as a partial defect of the lamina propria (LP). Treatment with fillers, such as fat or hyaluronic acid (HA), in the vocal folds is widely used, but the duration of effect is variable. Platelet-rich plasma (PRP) can enhance the survival of autologous fat in fat grafting, and also is used to treat sulcus vocalis. This study aimed to compare the effectiveness of autologous fat graft versus fat graft plus PRP to treat type II sulcus vocalis. Thirty-four patients with a voice handicap index (VHI) ≥ 11 were randomized to two groups, which received LP injections of fat graft (n = 17) or fat graft plus PRP (n = 17). At 1 month and 6 months after injection, the VHI decreased significantly in both groups. The fat plus PRP group had better Jitter, Shimmer, and noise to harmonic ratio (NHR) in 1 month and 6 months after surgery. The fat plus PRP group resulted in lower VHI scores one month after surgery, and stroboscopy revealed sustained smaller gaps after six months. These results indicate that a combination of fat graft plus PRP is safe and effective for treating sulcus vocalis type II and associated vocal atrophy.

Highlights

Vocal lamina propria defects are the leading cause of sulcus vocalis and are defined as type I, type II, and type III sulcus vocalis based on different degrees of injury of the lamina propria [1]
The three types of sulcus vocalis are defined by the degree of epithelial invagination into the superficial lamina propria (SLP)
A total of 34 patients with type II sulcus vocalis were included in the study, and 17 received an injection of fat alone, and 17 of them received an injection of fat plus Platelet-rich plasma (PRP)

Summary

Introduction

Vocal lamina propria defects are the leading cause of sulcus vocalis and are defined as type I, type II, and type III sulcus vocalis based on different degrees of injury of the lamina propria [1]. Apart from vocal palsy, the cause of glottic insufficiency is multifactorial, including vocal paralysis, vocal tumor, recurrent laryngeal neuropathy, myopathy, and vocal sulcus [3], which is considered a defect of Reinke’s space. The three types of sulcus vocalis are defined by the degree of epithelial invagination into the superficial lamina propria (SLP). Type I is considered to limit the SLP and have no functional impact. Type III has a large degree of deficiency and near-total loss of the SLP with the epithelium nearly contacting the vocal ligament [4]. Acquired vocal sulcus may be due to vocal cyst rupture and

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