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Management of Vocal Fold Scars by Concurrent Nanofat and Microfat Grafting

Cantarella, Giovanna, MD*,†; Mazzola, Riccardo F., MD*,†,‡

Journal of Craniofacial Surgery: May 2019 - Volume 30 - Issue 3 - p 692–695
doi: 10.1097/SCS.0000000000005206
Original Articles

Vocal fold scarring is the cause of severe dysphonia and represents a therapeutic challenge; dysphagia can also be present in case of soft tissue defect due to previous oncological surgery. The ideal surgical solution should concurrently provide vocal fold augmentation and re-establishment of tissue elasticity. Nanofat technique has given so far promising results in remodeling skin scars and improving tissue pliability. The present paper describes for the first time the use of nanofat injected into the vocal fold cover for pliability restoration, combined with traditional microfat for vocal fold augmentation. Seven patients (aged 23–77 years) affected by severe dysphonia, related to extensive vocal fold scarring (3 of them were also affected by dysphagia for liquid consistencies), underwent a single procedure of concurrent microfat and nanofat vocal fold injection under direct microlaryngoscopy in general anesthesia. Results were evaluated by objective outcome measures and auto evaluation performed by questionnaires concerning the phonatory and swallowing efficiency. The voice quality and the perceived swallowing capability of all patients improved after surgery and are stable at follow-up (4–8 months). The reported preliminary data show that nanofat, due to its regenerative potential related to adipose-derived stem cells and growth factors, can be a promising adjunct to traditional fat augmentation to improve elasticity of the delicate multilayered structure of the vocal fold and to enhance its vibratory capabilities. Further experience on a wider number of patients and long-term follow-up are necessary to confirm the validity of this technique.

*Otolaryngology Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico

Department of Clinical Sciences and Community Health, Milan University, Milan, Italy

Plastic Surgeon.

Address correspondence and reprint requests to Giovanna Cantarella, MD, Department of Otolaryngology, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; E-mail:

Received 2 November, 2018

Accepted 21 November, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.