Technical Advantages and Pitfalls in Vocal Cord Augmentation with Autologous Fat

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We describe here not only the technical up-sides but also the pitfalls of the intracordal autologous fat injection technique. Buccal fat pads were used for the following reasons: 1) No blood was visible in the fat at the time of collection thereby eliminating the need for rinsing and consequent removal of excessive water. Without admixed blood, the amount of fat available for injection could be accurately determined. 2) Fat harvesting was not limited by physical characteristics of the patient. 3) There are relatively few variations in the size of fat cells. 4) Compared with subcutaneous fat tissues used in the past, it is expected that the post-injection effects will last relatively longer. The determination of intracordal autologous fat injection sites is dependent on the laryngeal condition of the patient. With cases of unilateral vocal cord paralysis, the needle should be set at the middle of vocal cord membranous region and the injection should be made in to the center of vocal cord muscle. In cases of sulcus vocalis and vocal cord atrophy, the injection should firstly be made into the muscle and then the needle should be slightly drawn out and the injection made further into the mucosa. The ideal attributes of means of injection are as follows: 1) An 18G needle with 28cm in length, designed for injection under direct laryngoscopy. 2) A Motor-driven injection instrument for consistent injection procedure with gradual and constant speed. Injection procedure should be stopped (at the time) when the edge of the injected of vocal cord crosses over the median line. If an excess quantity is injected, there may be undesired influences on the para-glottic space, and a part of mucosa may collapse, resulting in the leakage of the injected fat tissue.

Technical Advantages and Pitfalls in Vocal Cord Augmentation with Autologous Fat

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