Original Research—Laryngology and Neurolaryngology Injection Laryngoplasty Using Micronized Acellular Dermis for Vocal Fold Paralysis: Long-term Voice Outcomes Otolaryngology– Head and Neck Surgery 2016, Vol. 154(5) 892–897 Ó American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599816630971 http://otojournal.org Stephen C. Hernandez, MD 1 , Haley Sibley 1 , Daniel S. Fink, MD 1,2 , Melda Kunduk, PhD, CCC-SLP 1,2,3 , Mell Schexnaildre, MA, CCC-SLP 2 , Anagha Kakade, MSC, DBM, PDCR 4 , and Andrew J. McWhorter, MD 1,2 No sponsorships or competing interests have been disclosed for this article. Abstract Objectives. Micronized acellular dermis has been used for nearly 15 years to correct glottic insufficiency. With previ- ous demonstration of safety and efficacy, this study aims to evaluate intermediate and long-term voice outcomes in those who underwent injection laryngoplasty for unilateral vocal fold paralysis. Technique and timing of injection were also reviewed to assess their impact on outcomes. Study Design. Case series with chart review. Setting. Tertiary care center. Subjects and Methods. Patients undergoing injection laryngo- plasty from May 2007 to September 2012 were reviewed for possible inclusion. Pre- and postoperative Voice Handicap Index (VHI) scores, as well as senior speech-language patholo- gists’ blinded assessment of voice, were collected for analysis. The final sample included patients who underwent injection lar- yngoplasty for unilateral vocal fold paralysis, 33 of whom had VHI results and 37 of whom had voice recordings. Additional data were obtained, including technique and timing of injection. Results. Analysis was performed on those patients above with VHI and perceptual voice grades before and at least 6 months fol- lowing injection. Mean VHI improved by 28.7 points at 6 to 12 months and 22.8 points at .12 months (P = .001). Mean percep- tual voice grades improved by 17.6 points at 6 to 12 months and 16.3 points at .12 months (P \ .001). No statistically significant difference was found with technique or time to injection. Conclusion. Micronized acellular dermis is a safe injectable that improved both patient-completed voice ratings and blinded reviewer voice gradings at intermediate and long-term follow- up. Further investigation may be warranted regarding technique and timing of injection. Keywords vocal fold paralysis, glottal incompetence, vocal cord injec- tion, injection laryngoplasty, micronized acellular dermis Received August 21, 2015; revised January 12, 2016; accepted January 15, 2016. U nilateral vocal fold paralysis (UVFP) with associated glottal incompetence is frequently encountered in general otolaryngology practices today. Patients often present with dysphonia, dysphagia, and recurrent aspiration. Procedures have been developed to minimize these symptoms by promoting glottic closure, including med- ialization thyroplasty, laryngeal reinnervation, and injection laryngoplasty. Brunings first introduced the concept of injec- tion laryngoplasty in 1911, 1 and multiple substances have since been developed for augmentation of the vocal fold. These include calcium hydroxylapatite, carboxymethylcellu- lose, hyaluronic acid derivatives, and many others. 2 Acellular dermis (AlloDerm; LifeCell Corporation, Somerville, New Jersey) is developed from processed cada- veric dermis after selective removal of dermal and epider- mal components. 3 What remains is an acellular matrix of collagen and elastin that is immunologically nonreactive and may allow for tissue in-growth and incorporation of the implant into the native tissue. Micronized acellular dermis 1 Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA 2 Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA 3 Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, USA 4 Merial Limited, North Brunswick, New Jersey, USA Work was done at the Louisiana State University School of Medicine and the Voice Centerof the Our Lady of the Lake Regional Medical Center. This article was presented at the 2015 AAO-HNSF Annual Meeting & OTO EXPO; September 27-30, 2015; Dallas, Texas. Corresponding Author: Stephen C. Hernandez, MD, Department of Otorhinolaryngology, Louisiana State University Health Sciences Center, 533 Bolivar St, Ste 566, New Orleans, LA 70112, USA. Email: sherna@lsuhsc.edu at SOCIEDADE BRASILEIRA DE CIRUR on May 6, 2016 oto.sagepub.com Downloaded from