The Regenerative Approach For The Management of Severe Dysphonia

Numerous clinical trials conducted all over the world have demonstrated the regenerative potential of fat grafting. Fat injection may treat an incomplete glottic closure, caused by unilateral vocal fold paralysis or by a soft tissue defect of the complex vocal fold structure. A paralyzed vocal fold becomes flaccid and hypotrophic and does not adduct on phonation, severely affecting the voice and sound production. Soft tissue defects are most frequently acquired, being the sequelae of previous surgery. Fat injection aims to achieve augmentation and medialization while preserving and improving the viscoelastic properties of the stratified microstructure of the vocal fold. It contributes to release the superficial adherences and to re-establish the gliding tissue in case of scarring which impairs vibration and sound production. Fat parcels are typically injected to obtain the medialization, whereas the recently introduced technique, known as nanofat, is a promising mean to favor the restoration of the superficial vocal fold layer when altered by scar tissue.