title: Restructuring the vocal fold lamina propria with endoscopic microdissection.
abstract: OBJECTIVE
  The purposes of this preclinical study were to investigate histologic and rheologic outcomes of Microendoscopy of Reinke's space (MERS)-guided minithyrotomy and to assess its instrumentation.
  
  
  METHODS
  Human cadaveric and in vivo animal study.
  
  
  METHODS
  Three human cadaveric larynges were treated with MERS-guided placement of Radiesse VoiceGel and immediately evaluated histologically for biomaterial location. In the second part of this investigation, two scarred porcine larynges were treated with MERS-guided placement of HyStem-VF and rheologically evaluated 6 weeks later. Student t tests determined differences in viscoelastic properties of treated/untreated vocal folds. Sialendoscopes and microendoscopes were subjectively compared for their visualization capacity.
  
  
  RESULTS
  MERS imaged the subepithelial area and vocal ligament, guiding both tissue dissection and biomaterial positioning. Sialendoscopes provided adequate visualization and feature incorporated working channels. Enhanced image clarity was created in a gas-filled rather than saline-filled environment, per rater judgment. Histological analysis revealed desirable biomaterial positioning with MERS. Per rheological analysis, viscoelastic properties of the MERS-treated porcine vocal folds compared to uninjured vocal folds 6 weeks following treatment did not statistically differ.
  
  
  CONCLUSIONS
  MERS-guided laryngoplasty using sialendoscopes yielded satisfactory biomaterial positioning in the short-term and normalized rheologic tissue properties in the long-term, contributing to proof of concept for MERS in the treatment of scarring. Strengths of MERS include direct, real-time visualization of Reinke's space and an ability to manipulate surgical instruments parallel to the vocal fold edge while maintaining an intact epithelium. Future work will explore the clinical utility of MERS for addressing scarring, sulcus vocalis, and other intracordal processes.
authors: Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, U.S.A.
authors: Rebecca S
authors: RS
authors: Bartlett
authors: Henry T
authors: HT
authors: Hoffman
authors: Seth H
authors: SH
authors: Dailey
authors: Jonathan M
authors: JM
authors: Bock
authors: Sarah A
authors: SA
authors: Klemuk
authors: Ryan W
authors: RW
authors: Askeland
authors: Jan S
authors: JS
authors: Ahlrichs-Hanson
authors: Andrew C
authors: AC
authors: Heaford
authors: Susan L
authors: SL
authors: Thibeault
mesh_terms: D000818:Animals; D001672:Biocompatible Materials / Q000008:administration & dosage; D002102:Cadaver; D002921:Cicatrix / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007820:Laryngeal Mucosa / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D042282:Microdissection; D012212:Rheology; D013552:Swine; D014827:Vocal Cords / Q000473:pathology / Q000601:surgery*
chemical_list: D001672:Biocompatible Materials
keywords: Laryngoscopy; Reinke's space; minithyrotomy; sialendoscopy; vocal fold scarring
references: Laryngoscope. 2007 Dec;117(12):2251-4
references: 17909445
references: Laryngoscope. 2010 May;120(5):995-1001
references: 20422697
references: Ann Otol Rhinol Laryngol. 2008 Jun;117(6):437-42
references: 18646440
references: Ann Otol Rhinol Laryngol. 1999 Jan;108(1):1-9
references: 9930534
references: Biomed Mater. 2012 Apr;7(2):024103
references: 22456756
references: Laryngoscope. 2010 Mar;120(3):537-45
references: 20131370
references: Ann Otol Rhinol Laryngol. 1989 Sep;98(9):668-73
references: 2782799
references: Tissue Eng. 2006 Aug;12(8):2171-80
references: 16968158
references: Ann Otol Rhinol Laryngol. 2008 Jul;117(7):510-4; discussion 515-6
references: 18700426
references: Tissue Eng Part B Rev. 2009 Sep;15(3):249-62
references: 19338432
references: J Voice. 2010 Sep;24(5):531-9
references: 19853410
references: Ann Biomed Eng. 2003 Apr;31(4):482-91
references: 12723689
references: Laryngoscope. 2007 Mar;117(3):516-21
references: 17334315
references: Tissue Eng. 2006 Nov;12(11):3201-7
references: 17518634
references: J Voice. 2009 Jul;23(4):399-407
references: 18395421
references: Ann Otol Rhinol Laryngol. 2012 Jul;121(7):490-6
references: 22844870
references: Acta Otorhinolaryngol Belg. 1996;50(4):253-64
references: 9001635