Hyaluronic acid for the treatment of vocal fold scars.
OBJECTIVE
In vocal fold scars the lamina propria layer is lost or deficient. Lamina propria replacement therapy remains a clinical challenge because this layer has a highly specialized three-dimensional organization of extracellular matrix molecules and unique viscoelastic properties. Use of a polymer such as hyaluronic acid appears most promising for replacement therapy because it has the optimal viscoelasticity and also plays a role in the maturation and maintenance of vocal fold lamina propria.


RESULTS
A variety of cross-linked hyaluronic acid formulations and growth factor therapies targeted to increase hyaluronic acid production have been used in the treatment of both acute and established vocal fold scars. Therapeutic strategies have focused on prevention of scar at the time of initial injury, and rejuvenation of lamina propria layer in established scars. Both strategies show improved histologic, viscoelastic, acoustic, and aerodynamic measures.


CONCLUSIONS
Cross-linked hyaluronic acid formulations appear useful in the treatment of vocal fold scarring. Their use at the time of acute injury especially appears to lessen the degree of long-term scar formation and appears promising. While animal studies have demonstrated the safety profile of many hyaluronic acid formulations, further improvement in these materials and well designed and controlled human trials are needed to further establish the safety and efficacy of these materials and therapeutic approaches.
Chhetri
Dinesh K
DK
62-132 CHS, Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. dchhetri@mednet.ucla.edu
Mendelsohn
Abie H
AH
D002921:Cicatrix / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D015552:Injections, Intralesional; D007818:Laryngeal Diseases / Q000188:drug therapy / Q000473:pathology; D008297:Male; D016896:Treatment Outcome; D014827:Vocal Cords / Q000187:drug effects* / Q000473:pathology; D014833:Voice Quality
D006820:Hyaluronic Acid