Long-term Outcome of Autologous Lipoinjection Medialization Laryngoplasty versus Type I Thyroplasty

Bailey Balouch; Philip J Maxwell; Swetha Vontela; Robert T Sataloff

doi:10.1016/j.jvoice.2023.10.012

Long-term Outcome of Autologous Lipoinjection Medialization Laryngoplasty versus Type I Thyroplasty

J Voice. 2023 Nov 6:S0892-1997(23)00321-1. doi: 10.1016/j.jvoice.2023.10.012. Online ahead of print.

Authors

Bailey Balouch¹, Philip J Maxwell², Swetha Vontela³, Robert T Sataloff⁴

Affiliations

¹ Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey.
² Drexel University College of Medicine, Philadelphia, Pennsylvania.
³ Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
⁴ Department of Otolaryngology, Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address: rtsataloff@phillyent.com.

PMID: 37940421
DOI: 10.1016/j.jvoice.2023.10.012

Abstract

Glottic insufficiency is incomplete or soft closure of the true vocal folds during phonation and is a common cause of dysphonia. Treatment includes voice therapy, type I thyroplasty, vocal fold injection augmentation (with materials such as autologous fat), arytenoid cartilage repositioning, or a combination of treatment modalities. The present study aimed to compare long-term outcomes of lipoinjection medialization with type I thyroplasty for patients with glottic insufficiency.

Methods: Adult voice center patients who had undergone surgical vocal fold medialization with autologous lipoinjection or with type I thyroplasty for glottic insufficiency were included in this retrospective study. The primary outcome measures were the need for further medialization surgery and improvement in the glottic gap.

Results: There were 172 subjects included in this study: 100 subjects underwent type I thyroplasty and 72 subjects underwent autologous lipoinjection medialization. Neither age nor gender differed significantly between thyroplasty and lipoinjection groups. The rate of further medialization surgery did not differ significantly between thyroplasty and lipoinjection groups, but further medialization surgery was performed longer after the initial operation in the thyroplasty group Baseline glottic gap did not differ significantly between thyroplasty and lipoinjection groups. When improvement from baseline was compared between thyroplasty and lipoinjection subjects, the improvement from baseline was similar for both groups at 6 months and at 12 months. Voice handicap index scores improved significantly after thyroplasty or after lipoinjection, and the improvement from baseline was similar in both cohorts.

Conclusion: Both autologous lipoinjection medialization and type I thyroplasty provide effective medialization for patients with glottic insufficiency. Both techniques yield similar reoperation rates, and the benefit of surgery appears to last for at least 1 year for most patients.

Keywords: Autologous lipoinjection medialization laryngoplasty; Fat injection; Glottic closure; Glottic insufficiency; Long-term outcomes; Type I thyroplasty.