Implantation of esterified hyaluronic acid in microdissected Reinke's space after vocal fold microsurgery: first clinical experiences

OBJECTIVE: In this pilot study are presented the first clinical experiences of the use of a resorbable bioimplant made of esterified hyaluronic acid inserted in the microdissected superficial layer of the lamina propria (SLLP), also called Reinke's space, after a flap excision procedure for a benign vocal fold lesion. Laryngeal and vocal evolution of implanted patients are depicted and discussed. STUDY DESIGN: Eleven bio-implants have been inserted in microdissected SLLP of 11 cases presenting with benign vocal fold lesions. The surgical procedure consisted of the excision of primary lesion by a microflap technique immediately followed by implantation of esterified hyaluronic acid in Reinke's space. METHODS: All patients underwent rigid laryngoscopy and a microsurgical procedure under general anesthesia. The cordal lesion was treated with cold instrumentation of Bouchayer (7 cases) or with a mixed technique using CO(2) laser (4 cases). After the classical freeing-up of Reinke's space and the creation of a mucosal flap, a few fibers of esterified hyaluronic bioimplant are gently arranged in Reinke's space before redraping the ligament and closing the cordal incision with a few drops of fibrin glue. Laryngeal and vocal assessments were performed pre- and postoperatively in all patients using videostroboscopy as well as perceptual and objective voice evaluation. All patients were followed in a longitudinal manner: between two and five postoperative evaluations were performed. The longest follow-up was 19 months and the shortest 2 months. RESULTS: All cases exhibited postsurgical improvement of the pliability of the SLLP. None of them developed an adverse scarring process. Improvement of SLLP's pliability was maintained in time in all cases. Vocal improvement was observed in all. Temporary inflammation was noted in one case. There were no serious adverse effects apparent during the follow-up period. CONCLUSION: Bio-implantation of esterified hyaluronic acid in Reinke's space is technically easy and well tolerated. All treated cases exhibited postoperative good pliability of the SLLP compared with their preoperative evaluation.