Implantation of esterified HA in microdissected Reinke’s space after vocal fold microsurgery : a controlled and prospective study of laryngeal and voice evolution.

Finck C., Remacle A., Duchesne AA., Lefebvre Ph.

Background. In a previous pilot study (1), we have presented the laryngeal and vocal evolution observed in 11 patients who benefited from the implantation of a resorbable implant made of esterified hyaluronic acid(EHA) in the micro-dissected superficial layer of the lamina propria (SLLP) after a flap excision procedure for a benign vocal fold lesion. The observed results were encouraging: the implant is well tolerated and all cases exhibited postsurgical improvement of the SLLP’s pliability.
Objective. Evaluation of the laryngeal and vocal outcome of 30 patients benefiting of implantation of EHA in Reinke’s space after a vocal fold microsurgery((5 open cysts, 1 sub-epithelial fibrosis, 4 polyps, 5 Reinke’s edemas, 2 vergetures, 1 scar, 6 nodules, 1 sulcus, 5 mucous cysts). Laryngeal and vocal assessments are performed pre- and postoperatively in all patients using video-stroboscopy (Wolff and Xion devices), perceptual and objective voice evaluation (CSL and MDVP software), and aerodynamic assessments (Aerophone).The longest follow-up is presently 5 years.
Preliminary results. In 26 cases, we observe a post surgical improvement of the pliability of the SLLP and of the voice. Improvement of mucosal wave is maintained in time in the 26 favourable cases.
Ongoing study. Vocal and laryngeal outcome of the study group are compared those of a control group undergoing vocal fold microsurgery but with no subsequent bio-implantation of EHA in Reinke’s space.
Conclusion. Excellent tolerance of EHA implanted in Reinke’s space as well as good SLLP’s pliability is confirmed by this larger serie. Comparison of obtained results in the study and control group will help to determine if increasing hyaluronic acid significantly improves pliability and functional results after VF’s microsurgery.

(1) Finck C, Lefebvre P. Implantation of esterified hyaluronic acid in micro-dissected Reinke’s space after vocal fold microsurgery: first clinical experiences. Laryngoscope 2005; 115: 1841-1847.

Finck C.,MD, Remacle A., Duchesne AA., Lefebvre Ph.
Department of Otorhinolaryngology, University of Liège, Belgium.
Dr Camille Finck
Service ORL et de Chirurgie Cervico-Faciale
CHU SartTilman
B-4000 Liège
Tel: 32 4 366 7269 Fax: 32 4 366 7525
e-mail : camille.finck@chu.ulg.ac.be camillefinck@scarlet.be