| Abstract [eng] |
Glottic insufficiency due to vocal fold paralysis, atrophy, sulcus vocalis, or post-resection scarring leads to significant voice impairment and may result in aspiration. Autologous fat injection laryngoplasty is an established minimally invasive technique for vocal fold medialization. However, no standardized protocol exists for fat harvesting, processing, or injection. This review evaluates how variations in autologous fat grafting techniques influence voice outcomes, graft longevity, and complication rates. A PRISMA-compliant review with narrative synthesis was conducted. PubMed, Cochrane Library (CENTRAL), and Scopus were searched in January 2026 for studies published between 2016 and 2026. Eight studies comprising 243 patients met the inclusion criteria. Due to substantial heterogeneity, a narrative synthesis was performed. Most studies reported improvement in subjective, perceptual, acoustic, and aerodynamic measures. Outcomes were more favorable in paralytic and atrophic conditions than in structurally altered vocal folds. Injection volume emerged as the most relevant modifiable factor, with higher volumes associated with improved outcomes and lower revision rates. In contrast, fat processing techniques showed no clear superiority, while correct placement within the thyroarytenoid muscle was essential. Adjunctive strategies, including platelet- rich plasma and scaffold-based approaches, showed variable and preliminary effects. Complication rates were low, and revision was primarily related to insufficient or declining medialization. Overall, autologous fat injection laryngoplasty is a safe and effective intervention. Injection volume and accurate placement appear to be an important modifiable factor of outcome, whereas no optimal processing technique can currently be identified. Further standardized, adequately powered studies with objective assessment of graft survival are required. |
