title: Fascia augmentation of the vocal fold: graft yield in the canine and preliminary clinical experience.
abstract: BACKGROUND
  Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance.
  
  
  METHODS
  A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model.
  
  
  METHODS
  Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months.
  
  
  RESULTS
  In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; range, 7%-96%; P =.57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation.
  
  
  CONCLUSIONS
  Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency.
authors.affiliation: Center for Voice Disorders, Department of Otolaryngology-Head and Neck Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1034, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Duke
authors.forename: J
authors.initials: J
authors.lastname: Salmon
authors.forename: P D
authors.initials: PD
authors.lastname: Blalock
authors.forename: G N
authors.initials: GN
authors.lastname: Postma
authors.forename: J A
authors.initials: JA
authors.lastname: Koufman
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D004285:Dogs; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000601:surgery; D007828:Laryngoscopy; D007830:Larynx / Q000166:cytology; D008875:Middle Aged; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014827:Vocal Cords / Q000601:surgery*; D014832:Voice Disorders / Q000601:surgery