Restructuring the vocal fold lamina propria with endoscopic microdissection

Rebecca S Bartlett; Henry T Hoffman; Seth H Dailey; Jonathan M Bock; Sarah A Klemuk; Ryan W Askeland; Jan S Ahlrichs-Hanson; Andrew C Heaford; Susan L Thibeault

doi:10.1002/lary.24146

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Restructuring the vocal fold lamina propria with endoscopic microdissection

Journal article

Peer reviewed

Restructuring the vocal fold lamina propria with endoscopic microdissection

Rebecca S Bartlett, Henry T Hoffman, Seth H Dailey, Jonathan M Bock, Sarah A Klemuk, Ryan W Askeland, Jan S Ahlrichs-Hanson, Andrew C Heaford and Susan L Thibeault

The Laryngoscope, Vol.123(11), pp.2780-2786

11/2013

DOI: 10.1002/lary.24146

PMCID: PMC3951149

PMID: 23959803

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Abstract

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. Human cadaveric and in vivo animal study. 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. 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. 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.

Animals

Biocompatible Materials - administration & dosage

Cadaver

Cicatrix - pathology

Cicatrix - surgery

Female

Humans

Laryngeal Mucosa - surgery

Laryngoscopy - methods

Microdissection

Rheology

Swine

Vocal Cords - pathology

Vocal Cords - surgery

Details

Title: Subtitle: Restructuring the vocal fold lamina propria with endoscopic microdissection
Creators: Rebecca S Bartlett - University of Wisconsin–Madison
Henry T Hoffman - University of Iowa
Seth H Dailey - University of Wisconsin–Madison
Jonathan M Bock - Medical College of Wisconsin
Sarah A Klemuk - University of Iowa
Ryan W Askeland - University of Iowa
Jan S Ahlrichs-Hanson - University of Iowa Hospitals and Clinics
Andrew C Heaford - University of Iowa Hospitals and Clinics
Susan L Thibeault - University of Wisconsin–Madison
Resource Type: Journal article
Publication Details: The Laryngoscope, Vol.123(11), pp.2780-2786
DOI: 10.1002/lary.24146
PMID: 23959803
PMCID: PMC3951149
NLM abbreviation: Laryngoscope
ISSN: 0023-852X
eISSN: 1531-4995
Grant note: L30 CA103913 / NCI NIH HHS R01 DC004336 / NIDCD NIH HHS
Language: English
Date published: 11/2013
Academic Unit: Radiation Oncology; Otolaryngology
Record Identifier: 9984311444902771

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