Prevention of anterior glottis web with hyaluronic acid derivatives in rabbit model.
Validating an antiadhesive strategy to prevent anterior glottic web (AGW) development.



Prospective animal study in rabbits.



Fifteen New Zealand white rabbits were randomly divided into three equal groups (five rabbits each), applying either HyFence (HF: 0.1 g/vocal fold), an antiadhesive test agent; mitomycin-C (MMC: 1 mg/ml, 4 min) as reference therapy; or saline (control group) to AGWs induced by laryngofissure technique (previously reported by us). At week 8, the extent of AGW was measured to assess preventive effects of HF and MMC, and laryngeal specimens were sampled for high-speed recording and histologic analysis.



AGW induction was successful in all five (100%) control rabbits, each demonstrating fibroconnective tissue and collagen fibers at anterior commissure, with AGW ratio averaging 0.57 ± 0.052. An AGW was seen in 100% of the rabbits survived in the MMC group (n = 2) with the 60% (n = 3) of the MMC rabbits expired due to postprocedure infections. The average AGW ratio was 0.28 ± 0.070 in the MMC group. AGW formation rate was 50% in HF group with one rabbit expired from infection. Mean AGW ratio was lowest in the HF group (0.23 ± 0.10; P = 0.013). Microscopically, AGW induction sites in HF-treated rabbits displayed significantly fewer collagen fibers (P = 0.009) by comparison.



This is the first reported use of a cross-linked hyaluronic acid gel that may prevent AGW formation.



N/A. Laryngoscope, 126:2320-2324, 2016.
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Seong Keun
SK
Kwon
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Yoon-Jong
YJ
Ryu
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Dong Wook
DW
Kim
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Hyun
H
Chang
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Soo Yeon
SY
Kim
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Myung Whun
MW
Sung
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea. jhunhah@snu.ac.kr.
J Hun
JH
Hah
D000818:Animals; D003094:Collagen / Q000187:drug effects; D004195:Disease Models, Animal; D005931:Glottis / Q000187:drug effects* / Q000473:pathology; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007818:Laryngeal Diseases / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D016685:Mitomycin / Q000008:administration & dosage; D011446:Prospective Studies; D011817:Rabbits; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage*; D014827:Vocal Cords / Q000187:drug effects / Q000473:pathology
D055675:Viscosupplements; D016685:Mitomycin; D006820:Hyaluronic Acid; D003094:Collagen
Anterior glottic web; antiadhesive agent; larynx; mitomycin-C; rabbit; stenosis