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Fat is theoretically the ideal implant for vocal fold augmentation because it is soft, easily available and biocompatible. However, reabsorption is a frequent cause of long-term failure.We prospectively tested Coleman's "lipostructure" technique used for facial recontouring in the treatment of glottic incompetence.Fourteen patients (aged 18-74 years, mean 48) with breathy dysphonia secondary to laryngeal hemiplegia (7) or anatomical defects (7) underwent vocal fold lipoinjection. Fat harvested by liposuction was centrifuged, and the fat cell layer injected into the vocalis muscle. The patients underwent pre- and postoperative videolaryngostroboscopy, maximum phonation time (MPT) measurements, GRBAS perceptual evaluations, and Voice Handicap Index (VHI) self-assessments.Voice quality improved soon after surgery and remained stable over 3-26 months (mean 10.6), being confirmed by the GRBAS, MPT and VHI evaluations ( P0.005). The results were best in the seven patients with paralytic dysphonia.Lipostructure is a valuable technique for voice rehabilitation in glottic incompetence.

Objectives: The aim of this prospective study was to verify whether vocal fold fat augmentation (VFFA) modifies upper airway patency. To the best of our knowledge, this is the first study analyzing the impact of VFFA on laryngeal resistance to airflow. Methods: Twenty-one consecutive patients 16 to 74 years of age underwent 24 VFFA operations because of glottic incompetence due to laryngeal hemiplegia (13 patients) or vocal fold tissue defects (8 patients). Flow-volume loop spirometry and body plethysmography were performed before and 1 to 6 months after surgery. Results: There were no significant differences between preoperative and postoperative pulmonary volumes (FVC and FEV1), expiratory flows (PEF, FEF50), or inspiratory flows (PIF, FIF50), although a slight increase in inspiratory flows meant that FEF50/FIF50 slightly decreased. Specific airway resistance (sRaw) increased after VFFA, but not in a statistically significant manner (p = .078). None of the patients experienced postoperative stridor. One obese woman with laryngeal hemiplegia had postoperative effort dyspnea; her respiratory studies showed a reduction in inspiratory flows and an increase in sRaw, and demonstrated progressive improvement. Conclusions: Flow-volume loop spirometry showed that VFFA does not significantly modify respiratory airflows, although a slight increase of inspiratory airflows suggested an improvement in variable extrathoracic obstruction. Body plethysmography proved to be a sensitive procedure that highlighted the subtle increase in upper airway resistance. Hence, VFFA can be considered a relatively safe procedure for achieving vocal fold medialization, and spirometry and plethysmography can be useful for preoperative assessment and postoperative follow-up.

International audience; OBJECTIVE:The aim of this study was to analyze the effects of botulinum toxin (BT) injection on airflow stability, by measuring mean phonatory oral airflow and its coefficient of variation (CV), in subjects with adductor spasmodic dysphonia (SD).STUDY DESIGN AND SETTING:Twenty-four subjects with SD (aged 31-78 years) and 23 controls (aged 29-63 years) were evaluated for mean airflow and its CV during sustained phonation. Fifteen of the subjects with SD were also evaluated within 3 weeks after BT injection.RESULTS:BT increased airflow in subjects (P = 0.0130) but neither the preinjection nor postinjection values differed significantly from those of controls. Conversely, airflow CV was invariably higher in subjects than in controls (P < 0.0001). In 13 subjects in whom phonation perceptually improved, including 3 in whom airflow did not increase, airflow CV decreased significantly after BT treatment (P = 0.0232).CONCLUSIONS:Subjects with SD have highly unstable phonatory airflow; its CV is a valid measure for assessing the outcome of a BT injection. A reduced airflow CV probably does not depend solely on increased airflow due to thyroarytenoid muscle paresis, and may indicate a change in laryngeal motoneuronal activity.

Objectives: This study was designed to analyze whether respiratory flows and specific airway resistance (sRaw) depend on the degree of breathiness and on the position of the paralyzed vocal fold in laryngeal hemiplegia. Methods: We performed a prospective study involving 55 patients affected by laryngeal hemiplegia. Results: The paralyzed fold was in an intermediate position in 18 cases and in a paramedian position in 37. Breathiness was estimated with the GRBAS scale, and the patients were divided into four groups: B0 (12 patients), B1 (14), B2 (16), and B3 (13). Spirometry was used to measure the flow-volume loop, and body plethysmography was used to measure the sRaw at increasing respiratory frequencies (30 ± 5, 60 ± 5, and 90 ± 5 breaths per minute). The mean inspiratory flows (PIF, FIF50) were lower than predicted (1, as is typical of variable extrathoracic obstruction. The mean sRaw values increased with respiratory frequency, and the increase was higher in group B3, although the values varied widely. The frequency-dependent increase in the sRaw value was not significantly related to the degree of breathiness, nor to the position of the paralyzed fold. Furthermore, Spearman's coefficient did not reveal any correlation between the sRaw values and inspiratory flows, showing that plethysmography and spirometry explore different aspects of airway function. Conclusions: Respiratory flows and sRaw are not significantly influenced by either the degree of breathiness or the position of the paralyzed vocal fold.

Objectives: The aim of this study was to analyze the effects of botulinum toxin (BT) injection on mean phonatory airflow and its coefficient of variation (CV) in patients with adductor spasmodic dysphonia (SD). Methods: Mean oral airflow and its CV were measured in 15 SD patients (age, 31–78 years) and 23 controls (age, 29–63 years) during sustained emission of the vowel /a/. The measurement was repeated in the SD patients 3–4 weeks after BT injection. Results: Mean airflow increased in the SD patients after BT treatment (P = 0.02) but neither the pre- and posttreatment values were significantly different from those of controls. Airflow CV was much higher in the SD patients (P < 0.0001), but significantly decreased after BT treatment (P = 0.01) in 13 perceptually improved patients, including 3 showing an unchanged airflow. Conclusions: These results confirm that patients with SD have a highly unstable phonatory airflow and that airflow CV can be a valuable measure of treatment outcome after a BT injection. The reduction in airflow CV is not strictly related to increased airflow due to thyroarytenoid muscle paresis and may be a sign of a change in the activity of laryngeal motoneurons.