title: Functional and Histological Evaluation following Canine Vocal Fold Reconstruction Using Composite Thyroid Ala Perichondrium Flaps.
abstract: OBJECTIVE
  We evaluated the effects of vocal fold reconstruction using a composite thyroid ala perichondrium flap (CTAP) after unilateral vocal fold stripping in beagles. We hypothesized that CTAP would improve glottic closure, decrease phonation threshold pressure, and decrease perturbation. In addition, vocal folds with CTAP would exhibit neovascularization and fat with increased von Willebrand factor (vWF) and smooth muscle actin (SMA), reflecting neoangiogenesis and flap viability.
  
  
  METHODS
  Randomized controlled trial using beagles.
  
  
  METHODS
  University laboratory.
  
  
  METHODS
  Ten beagles underwent unilateral vocal fold stripping. Dogs in the scar-only group (n = 5) were sacrificed at 1 month. Dogs in the CTAP group (n = 5) underwent ipsilateral reconstruction with CTAP at 1 month and were sacrificed at 2 months. Excised larynx experiments evaluated vocal fold vibration using aerodynamic, acoustic, and mucosal wave measurements. Qualitative evaluation of vocal fold morphology and quantitative analysis of elastin, collagen, glycosaminoglycans, vWF, SMA, and hyaluronic acid were performed.
  
  
  RESULTS
  Phonation threshold pressure (P = .005), percent jitter (P = .010), percent shimmer (P = .007), and open quotient (P = .007) were lower in the CTAP group. Neovascularization (P = .0079) and fat (P = .1667) occurred more with CTAP, although the difference in fat was not significant. von Willebrand factor was higher with CTAP vs contralateral normal fold (P = .110), although not statistically significant. Smooth muscle actin was higher with CTAP vs contralateral normal fold (P = .038) and scarred vocal folds (P = .022).
  
  
  CONCLUSIONS
  Composite thyroid ala perichondrium flap restored glottic closure and vibratory periodicity following vocal fold scarring. Additional investigation on biologic response is warranted. Composite thyroid ala perichondrium flap offers an autologous, vascularized implant that can improve both vocal fold structure and function.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Hoffman
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Glab
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: McLean
authors.initials: M
authors.lastname: Gunderson
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Maytag
authors.affiliation: Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Yang
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jiang
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA dailey@surgery.wisc.edu.
authors.forename: Seth H
authors.initials: SH
authors.lastname: Dailey
mesh_terms: D000818:Animals; D002921:Cicatrix / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D004195:Disease Models, Animal; D004285:Dogs; D008297:Male; D010699:Phonation / Q000502:physiology; D013524:Surgical Flaps; D013536:Suture Techniques; D013957:Thyroid Cartilage / Q000637:transplantation*; D014732:Vibration; D014827:Vocal Cords / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*
keywords: acoustic; aerodynamic; composite thyroid ala perichondrium flap; glottic insufficiency; vocal fold augmentation; vocal fold scar