Abstract
OBJECTIVES: Glottal insufficiency can lead to persistent hoarseness and aspiration, and some patients require surgical intervention. Vocal fold injection can improve glottic structure, but the effect of postoperative voice therapy on voice quality remains to be evaluated. This study aims to analyze the clinical efficacy of vocal fold injection with fat and rectus abdominis fascia combined with voice training in the treatment of glottal insufficiency. METHODS: Clinical data of 15 patients with glottal insufficiency treated in the Department of Otolaryngology-Head and Neck Surgery of the Second Affiliated Hospital of Nanchang University from August 2018 to December 2024 were retrospectively collected. Patients received injection of fat and rectus abdominis fascia into the middle portion of the paralyzed vocal fold, and voice training was initiated 2 weeks after surgery. Patients were evaluated and followed up before surgery and at 3, 6, and 12 months after surgery. The primary outcome indicator was the change in glottal gap. Secondary outcome indicators included voice acoustic parameters, including maximum phonation time (MPT), normalized noise energy (NNE), shimmer, and jitter, as well as the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale score. RESULTS: In all treated patients, the injected vocal fold was fuller than before surgery, and no leakage of injected material occurred. The injected vocal fold appeared thickened and shifted medially. Hyperemia and edema were observed within 1 week after surgery, and redness and swelling subsided after 2 months. Compared with before treatment, glottal gap, NNE, shimmer, jitter, and GRBAS scores were significantly reduced at 3, 6, and 12 months after treatment, while MPT was significantly prolonged, with statistically significant differences (all P<0.05). With the increase in the number of voice training sessions, the therapeutic effect became more significant. No patient required secondary vocal fold injection during the 12-month follow-up period. CONCLUSIONS: Vocal fold injection with fat and rectus abdominis fascia combined with voice training can improve glottal closure and voice quality in patients with glottal insufficiency during short- and mid-term follow-up, and is a feasible treatment.