Voice Outcomes of Lipoinjection Versus Medialization Laryngoplasty for Nonparalytic Glottic Insufficiency

Objective: To compare voice outcomes of autogenous fat injection versus medialization laryngoplasty in patients with glottic insufficiency due to vocal fold paresis or atrophy.

Methods: A retrospective review was performed from 2009 to 2017 of all patients who underwent lipoinjection or medialization laryngoplasty (ML) for glottic insufficiency. Charts were reviewed for demographic information, preoperative diagnosis, surgical intervention, Voice Handicap Index-10 (VHI-10) and Glottal Function Index (GFI) scores, follow-up time (minimum 3 months), and concomitant voice therapy.

Results: Eighty-three patients were initially identified and limited to 28 based on the inclusion/exclusion criteria. Thirty-five procedures were performed with a total of 15 fat injections and 20 MLs. The mean age was 60.7 years in the lipoinjection group and 55.6 years in the ML group. There was no significant difference in pretreatment VHI-10 scores between the two groups. Using the lowest recorded voice scores during the follow-up period, both groups had a significant decrease (P < 0.05) compared to preoperative scores (VHI-10: fat decreased from 27.8 to 14.2, ML decreased from 30.5 to 9.1; GFI: fat decreased from 13.7 to 5.27, ML decreased from 13.6 to 4.6). When evaluating the entire follow-up period (median 19 months in fat group, 16.3 months in ML), only the ML group maintained a significant improvement in VHI-10 (median delta 14.5) and GFI (median delta 7) compared to preoperative scores.

Conclusion: Although both autogenous fat injection and ML result in improved voice scores in the short term, the effect of fat injection appears to be limited, as evidenced by worsening VHI-10 and GFI scores over time.

Level of evidence: 4 Laryngoscope, 129:1164-1168, 2019.