Injection laryngoplasty with micronized dermis: a 10-year experience with 381 injections in 344 patients.
OBJECTIVE
Micronized Dermis (MD) has been used for injection laryngoplasty for correction of glottic insufficiency since 2000. There is controversy whether the material is temporary or permanent. This is a retrospective review of 381 injections in 344 patients. From this review, we hope to better define the role of MD in injection laryngoplasty.


METHODS
Retrospective chart review from a single surgeon (2000-2010)


RESULTS
The indications for MD were for both temporary and permanent correction of glottic insufficiency. The diagnoses were: vocal fold paralysis (n = 216), scar (n = 51), atrophy (n = 42), sulcus (n = 22), and others (n = 13). The material has the best effect when placed into the membranous vocal fold just lateral to the vocal ligament. The operative and postoperative complication was 1.05%. Twenty-nine percent of all injections resulted in unwanted absorption. Overinjection was needed and transcervical approach was preferred to prevent implant extrusion with overinjection. The median volume of injected material has increased from 0.8 cc to 1.0 cc over the decade. In 159 patients with long-term follow-up (>1 year), there was a 14% incidence of reinjection. Despite this, the overall need for open procedures in patients with long-term follow-up was 20%.


CONCLUSIONS
Despite the problems of inconsistency in preparation, slow absorption and need for overinjection, micronized dermis is a safe allograft material that has long-term (>1 year) stability. The material may reduce the need for open surgery. It can be used for both temporary and permanent vocal fold augmentation.
Department of Otolaryngology Head and Neck Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Melin
M
Tan
Peak
P
Woo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020405:Dermis / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D058753:Laryngoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery*; D055815:Young Adult