The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency
Objectives/Hypothesis To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency. Study Design Prospective clinical pilot study. Methods After several prior reconstructive attempts (followin...
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| Veröffentlicht in: | The Laryngoscope 2017-05, Vol.127 (5), p.1125-1130 |
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| creator | Caffier, Philipp P. I. Nasr, Ahmed Weikert, Sebastian Rummich, Julius Gross, Manfred Nawka, Tadeus |
| description | Objectives/Hypothesis
To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency.
Study Design
Prospective clinical pilot study.
Methods
After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre‐/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic‐aerodynamic analysis).
Results
In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre‐ and postoperative findings were not significant.
Conclusions
The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case.
Level of Evidence
4 Laryngoscope, 127:1125–1130, 2017 |
| doi_str_mv | 10.1002/lary.26261 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1859729318</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1859729318</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3851-961eb3b9face533d0a5e5e832cb9246ff8c5b30ec5ea670f57a9f7edf4639c0f3</originalsourceid><addsrcrecordid>eNp90U1rFDEYB_Agil2rFz-ABLyIMG1eNpPkWEp9gYWCVNBTyGSedLNkZ9YkQzvf3ky3euihpxzye_48PH-E3lNyRglh59Gm-Yy1rKUv0IoKTpu11uIlWtVP3ijBfp2gNznvCKGSC_IanTAppOKSrlC82QKeMuDR4zDswBXbRcDORhemPd7OfRrv52gPtoQCleBSB_KUbkM1ccaHBCWBLdDjZY_hHt-FssW3cSzFxjqQJ--DCzC4-S165W3M8O7xPUU_v1zdXH5rNtdfv19ebBrHlaCNbil0vNPeOhCc98QKEKA4c51m69Z75UTHCTgBtpXEC2m1l9D7dcu1I56fok_H3EMa_0yQi9mH7CBGO8A4ZUOV0JJpTlWlH5_Q3TiloW5nGOetbrli8jlFlZJLC2RRn4_KpTHnBN4cUtjXoxhKzGLMciHz0FTFHx4jp24P_X_6r5oK6BHchQjzM1Fmc_Hj9zH0L_a0n9s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1887100207</pqid></control><display><type>article</type><title>The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Caffier, Philipp P. ; I. Nasr, Ahmed ; Weikert, Sebastian ; Rummich, Julius ; Gross, Manfred ; Nawka, Tadeus</creator><creatorcontrib>Caffier, Philipp P. ; I. Nasr, Ahmed ; Weikert, Sebastian ; Rummich, Julius ; Gross, Manfred ; Nawka, Tadeus</creatorcontrib><description>Objectives/Hypothesis
To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency.
Study Design
Prospective clinical pilot study.
Methods
After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre‐/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic‐aerodynamic analysis).
Results
In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre‐ and postoperative findings were not significant.
Conclusions
The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case.
Level of Evidence
4 Laryngoscope, 127:1125–1130, 2017</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1002/lary.26261</identifier><identifier>PMID: 27578371</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Biocompatible Materials - therapeutic use ; Calcium ; Calcium hydroxylapatite ; Durapatite - therapeutic use ; Female ; glottal insufficiency ; Glottis - drug effects ; Humans ; Hydroxyapatite ; injection laryngoplasty ; Injections, Intralesional ; Laryngeal Diseases - drug therapy ; Laryngeal Diseases - surgery ; Larynx ; Larynx - drug effects ; Larynx - surgery ; Male ; Microspheres ; Middle Aged ; Pilot Projects ; Postoperative Complications - drug therapy ; Prospective Studies ; Radiesse Voice ; scarred larynx ; Stroboscopy ; Throat surgery ; Treatment Outcome ; Vocal Cords - drug effects ; vocal function ; Voice Disorders - drug therapy ; Voice Disorders - surgery</subject><ispartof>The Laryngoscope, 2017-05, Vol.127 (5), p.1125-1130</ispartof><rights>2016 The American Laryngological, Rhinological and Otological Society, Inc.</rights><rights>2017 The American Laryngological, Rhinological and Otological Society, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3851-961eb3b9face533d0a5e5e832cb9246ff8c5b30ec5ea670f57a9f7edf4639c0f3</citedby><cites>FETCH-LOGICAL-c3851-961eb3b9face533d0a5e5e832cb9246ff8c5b30ec5ea670f57a9f7edf4639c0f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flary.26261$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flary.26261$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27578371$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Caffier, Philipp P.</creatorcontrib><creatorcontrib>I. Nasr, Ahmed</creatorcontrib><creatorcontrib>Weikert, Sebastian</creatorcontrib><creatorcontrib>Rummich, Julius</creatorcontrib><creatorcontrib>Gross, Manfred</creatorcontrib><creatorcontrib>Nawka, Tadeus</creatorcontrib><title>The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency</title><title>The Laryngoscope</title><addtitle>Laryngoscope</addtitle><description>Objectives/Hypothesis
To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency.
Study Design
Prospective clinical pilot study.
Methods
After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre‐/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic‐aerodynamic analysis).
Results
In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre‐ and postoperative findings were not significant.
Conclusions
The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case.
Level of Evidence
4 Laryngoscope, 127:1125–1130, 2017</description><subject>Adult</subject><subject>Aged</subject><subject>Biocompatible Materials - therapeutic use</subject><subject>Calcium</subject><subject>Calcium hydroxylapatite</subject><subject>Durapatite - therapeutic use</subject><subject>Female</subject><subject>glottal insufficiency</subject><subject>Glottis - drug effects</subject><subject>Humans</subject><subject>Hydroxyapatite</subject><subject>injection laryngoplasty</subject><subject>Injections, Intralesional</subject><subject>Laryngeal Diseases - drug therapy</subject><subject>Laryngeal Diseases - surgery</subject><subject>Larynx</subject><subject>Larynx - drug effects</subject><subject>Larynx - surgery</subject><subject>Male</subject><subject>Microspheres</subject><subject>Middle Aged</subject><subject>Pilot Projects</subject><subject>Postoperative Complications - drug therapy</subject><subject>Prospective Studies</subject><subject>Radiesse Voice</subject><subject>scarred larynx</subject><subject>Stroboscopy</subject><subject>Throat surgery</subject><subject>Treatment Outcome</subject><subject>Vocal Cords - drug effects</subject><subject>vocal function</subject><subject>Voice Disorders - drug therapy</subject><subject>Voice Disorders - surgery</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90U1rFDEYB_Agil2rFz-ABLyIMG1eNpPkWEp9gYWCVNBTyGSedLNkZ9YkQzvf3ky3euihpxzye_48PH-E3lNyRglh59Gm-Yy1rKUv0IoKTpu11uIlWtVP3ijBfp2gNznvCKGSC_IanTAppOKSrlC82QKeMuDR4zDswBXbRcDORhemPd7OfRrv52gPtoQCleBSB_KUbkM1ccaHBCWBLdDjZY_hHt-FssW3cSzFxjqQJ--DCzC4-S165W3M8O7xPUU_v1zdXH5rNtdfv19ebBrHlaCNbil0vNPeOhCc98QKEKA4c51m69Z75UTHCTgBtpXEC2m1l9D7dcu1I56fok_H3EMa_0yQi9mH7CBGO8A4ZUOV0JJpTlWlH5_Q3TiloW5nGOetbrli8jlFlZJLC2RRn4_KpTHnBN4cUtjXoxhKzGLMciHz0FTFHx4jp24P_X_6r5oK6BHchQjzM1Fmc_Hj9zH0L_a0n9s</recordid><startdate>201705</startdate><enddate>201705</enddate><creator>Caffier, Philipp P.</creator><creator>I. Nasr, Ahmed</creator><creator>Weikert, Sebastian</creator><creator>Rummich, Julius</creator><creator>Gross, Manfred</creator><creator>Nawka, Tadeus</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201705</creationdate><title>The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency</title><author>Caffier, Philipp P. ; I. Nasr, Ahmed ; Weikert, Sebastian ; Rummich, Julius ; Gross, Manfred ; Nawka, Tadeus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3851-961eb3b9face533d0a5e5e832cb9246ff8c5b30ec5ea670f57a9f7edf4639c0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biocompatible Materials - therapeutic use</topic><topic>Calcium</topic><topic>Calcium hydroxylapatite</topic><topic>Durapatite - therapeutic use</topic><topic>Female</topic><topic>glottal insufficiency</topic><topic>Glottis - drug effects</topic><topic>Humans</topic><topic>Hydroxyapatite</topic><topic>injection laryngoplasty</topic><topic>Injections, Intralesional</topic><topic>Laryngeal Diseases - drug therapy</topic><topic>Laryngeal Diseases - surgery</topic><topic>Larynx</topic><topic>Larynx - drug effects</topic><topic>Larynx - surgery</topic><topic>Male</topic><topic>Microspheres</topic><topic>Middle Aged</topic><topic>Pilot Projects</topic><topic>Postoperative Complications - drug therapy</topic><topic>Prospective Studies</topic><topic>Radiesse Voice</topic><topic>scarred larynx</topic><topic>Stroboscopy</topic><topic>Throat surgery</topic><topic>Treatment Outcome</topic><topic>Vocal Cords - drug effects</topic><topic>vocal function</topic><topic>Voice Disorders - drug therapy</topic><topic>Voice Disorders - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Caffier, Philipp P.</creatorcontrib><creatorcontrib>I. Nasr, Ahmed</creatorcontrib><creatorcontrib>Weikert, Sebastian</creatorcontrib><creatorcontrib>Rummich, Julius</creatorcontrib><creatorcontrib>Gross, Manfred</creatorcontrib><creatorcontrib>Nawka, Tadeus</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Caffier, Philipp P.</au><au>I. Nasr, Ahmed</au><au>Weikert, Sebastian</au><au>Rummich, Julius</au><au>Gross, Manfred</au><au>Nawka, Tadeus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency</atitle><jtitle>The Laryngoscope</jtitle><addtitle>Laryngoscope</addtitle><date>2017-05</date><risdate>2017</risdate><volume>127</volume><issue>5</issue><spage>1125</spage><epage>1130</epage><pages>1125-1130</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><abstract>Objectives/Hypothesis
To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency.
Study Design
Prospective clinical pilot study.
Methods
After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre‐/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic‐aerodynamic analysis).
Results
In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre‐ and postoperative findings were not significant.
Conclusions
The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case.
Level of Evidence
4 Laryngoscope, 127:1125–1130, 2017</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27578371</pmid><doi>10.1002/lary.26261</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Biocompatible Materials - therapeutic use Calcium Calcium hydroxylapatite Durapatite - therapeutic use Female glottal insufficiency Glottis - drug effects Humans Hydroxyapatite injection laryngoplasty Injections, Intralesional Laryngeal Diseases - drug therapy Laryngeal Diseases - surgery Larynx Larynx - drug effects Larynx - surgery Male Microspheres Middle Aged Pilot Projects Postoperative Complications - drug therapy Prospective Studies Radiesse Voice scarred larynx Stroboscopy Throat surgery Treatment Outcome Vocal Cords - drug effects vocal function Voice Disorders - drug therapy Voice Disorders - surgery |
| title | The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency |
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