Objective:

Provide preliminary results regarding the safety and efficacy of fascia implantation medialization using a novel technique.

Methods:

A retrospective review was conducted using the electronic medical record of patients who underwent fascia implantation medialization laryngoplasty. Patient demographics, preoperative and postoperative examination including videostroboscopy, and subjective voice quality ratings using the Voice Handicap Index-10 (VHI-10) were collected. Open and closed phases during videostroboscopy were captured as still images. The glottic gap was assessed preoperatively, as well as at three postoperative time points. Statistical analysis was performed using SPSS software.

Results:

There were 30 subjects included in this study who underwent fascia implantation medialization laryngoplasty. The average age was 41.3 ± 18.7. There were 11 (36.7%) men and 19 (63.3%) women. Two subjects (6.7%) underwent bilateral fascia implantation and 28 (93.3%) underwent unilateral implantation. Glottic gap did not decrease significantly at the first or second postoperative time point. However, glottic gap decreased significantly at the third postoperative time point (n = 10, 8.6 ± 7.3 versus 15.0 ± 8.8, difference = 6.435 [1.492-11.378], p = 0.016). VHI-10 did not decrease significantly following fascia implantation medialization (n = 9, 18.6 ± 5.7 versus 20.2 ± 7.6, difference = 1.667 [-3.315-6.648], p = 0.463). In total, eight subjects (26.7%) elected to undergo revision medialization surgery. Four underwent thyroplasty and four underwent lipoinjection medialization. Revision medialization was performed an average of 208.8 ± 186.2 days (range = 28 – 510 days) following fascia implantation. The overall rate of partial or complete fascia extrusion was 23.2% (n = 7). Implant extrusion occurred an average of 13.1 ± 17.0 days postoperatively (range = 0 – 51 days) and required explant in the operating room in four (13.3%) cases. After initially noticing a high rate of fascia extrusion, the operative technique was modified to implant multiple smaller fragments of material rather than a single larger piece. Following modification of the technique, the rate of implant extrusion was 0.0%

Conclusion:

Fascia implantation medialization laryngoplasty is a safe surgical procedure. Novel fascia implantation techniques, such as using whole-sheet or multiple small fragments, may reduce extrusion rates.