Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite.

Abstract

To evaluate 5-year voice outcomes of vocal fold augmentation (VFA) using autologous fat (AF) injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Retrospective study of patients who underwent VFA between 2012 and 2015, with a 5-year follow-up. Patients with a glottic gap of ≤ 3mm caused by unilateral vocal fold paralysis or vocal fold atrophy were included in the study. VFA was performed using AF injection via direct microlaryngoscopy in 17 patients, and using office-based CaHA injection in 19 patients. Subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection, and at 12 and 60months post-VFA. Altogether 36 patients underwent VFA between 2012 and 2015, of whom 5 were excluded within 1year post-VFA, and 2 were excluded between 1 and 5years post-VFA. Of the remaining 29 patients, 3 (10.3%) underwent re-intervention at between 1 and 3years post-VFA. Thus, the 5-year follow-up included 26 patients (72.2%; 11 males and 15 females). At 5years after surgery, 73.1% of the patients were satisfied with their voice, with no significant between-group difference (P=0.307). The mean improvement of VHI was 28.8±17.82 in the autologous fat group versus 33±26.24 in the CaHA group (P=0.458). MPT improvement was also similar between the two groups: 6.2±4.26 for the autologous fat group versus 6.3±4.34 for the CaHA group (P=0.667). Both AF injection via direct microlaryngoscopy and office-based CaHA injection yielded good and comparable 5-year results.