Preliminary Report of Vocal Fold Augmentation with Cross-Linked Porcine Collagen

Abstract

Objective. To evaluate the short-term outcomes of using cross-linked porcine collagen for vocal fold augmentation. Study Design. Case series with planned data collection. Setting. Tertiary referral hospital. Subjects and Methods. Twenty consecutive patients of unilateral vocal fold paralysis (UVFP) were recruited, including 10 males and 10 females. All the subjects received videolaryngostroboscopic (VLS) evaluation for the glottic closure pattern, perceptual grading using the GRB scale (grade, roughness, breathiness), acoustic analysis, maximal phonation time (MPT), and Voice Handicap Index (VHI) questionnaire. Purified telopeptide-free, glutaraldehyde cross-linked porcine collagen was injected under local anesthesia with fiberscopic guidance. Results. Treatment outcomes were evaluated 3 months after the injection. Fifteen (75%) of 20 patients reported complete resolution of symptoms, whereas the other 5 (25%) patients had substantial improvements. The median score of perceptual analysis of voice quality showed significant improvements from G2/R2/B2 to G1/R1/B0 ( P < .001). Glottic closure pattern under stroboscopy had improved from “predominantly open” before the procedure to a “half-open and half-close” pattern after the procedure ( P < .001). Acoustic analysis demonstrated significant improvements of jitter and normalized noise energy ( P < .05). Maximal phonation time revealed a significant improvement from 7.5 ± 3.2 seconds to 13.1 ± 3.9 seconds ( P < .01). The VHI had also decreased from 53 ± 25 points to 27 ± 20 points ( P < .01). No patients had serious adverse events during the follow-up period. Conclusion. This case series demonstrated that porcine collagen may be a suitable material for temporary vocal fold augmentation.