title: Pedicled fat flap reconstruction of the atrophic or "empty" paraglottic space following resection of teflon granuloma or oversized implant.
abstract: OBJECTIVE
  Loss of functional and supporting architecture in the paraglottic space (PGS) necessitates augmentation to restore phonation and prevent aspiration. Our previous PGS reconstructions using an inferiorly based sternohyoid muscle flap have shown a propensity to fibrose over time, tethering the vocal fold inferolaterally. Poor voice outcomes have led us to explore other reconstructive options such as the laterally based vascularized fat flap described below. Our objectives in the present study were 1) to discuss phonosurgical options for reestablishing PGS volume after removal of an oversized implant or after definitive resection of Teflon granuloma; and 2) to understand the surgical technique, indications, and functional prognosis of the laterally based fat flap used for augmenting the "e mpty" PGS. Fourteen cases of PGS reconstruction with a laterally based subplatysmal fat flap were retrospectively investigated for indications, functional outcome, and the need for subsequent phonosurgical procedures. Preoperative and postoperative voice and videostroboscopic findings were analyzed.
  
  
  RESULTS
  Fat flap augmentation helped achieve subjective vocal improvement in patients with an empty PGS. A subset of our patients demonstrated fat flap atrophy within 12 months, prompting revision laryngoplasty. Viable flaps were encountered in each revision, facilitating future medialization attempts.
  
  
  CONCLUSIONS
  Fat flap reconstruction of the PGS is a versatile, beneficial adjunct for revision medialization in select cases.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232-8605 , USA.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Conoyer
authors.forename: James L
authors.initials: JL
authors.lastname: Netterville
authors.forename: Anton
authors.initials: A
authors.lastname: Chen
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Vos
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D001284:Atrophy; D005260:Female; D005500:Follow-Up Studies; D015745:Granuloma, Foreign-Body / Q000139:chemically induced / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000473:pathology*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality
chemical_list: D011138:Polytetrafluoroethylene