Intracordal platelet rich plasma injection protocol
DOI:
https://doi.org/10.34631/sporl.3109Keywords:
laryngology, dysphonia, vocal cord, atrophy, groove, scar, injection laryngoplasty, platelet rich plasmaAbstract
Introduction: Vocal fold atrophy, scarring and sulcus vocalis atrophy are benign pathologies characterized by inadequate remodeling of the lamina propria, affecting vocal fold vibration. The treatment of these conditions is complex and often results in unsatisfactory outcomes, which has led to increasing research into the regenerative potential of biological therapies, such as platelet-rich plasma (PRP). Intracordal injection of this autologous product has proven to be safe and effective in optimizing vocal quality.
Objectives: To propose a protocol for preparation and intracordal injection of PRP, and subsequent evaluation of its safety and efficacy.
Material and Methods: Literature review.
Results: The protocol defines the selection criteria for the target population, describes the PRP preparation and application technique, and the monitoring method after the intervention.
Conclusion: It is important to innovate the treatment of these pathologies in order to optimize vocal quality. Given the promising results of intracordal PRP injection, the implementation of this protocol will allow its systematic integration into clinical practice and the development of scientific research in this area.
Downloads
References
Simpson B, Rosen C. Operative Techniques in Laryngology. Heidelberg: Springer Berlin; 2008. 312 p. https://doi.org/10.1007/978-3-540-68107-6
Hirano S, Sugiyama Y, Kaneko M, Mukudai S, Fuse S, Hashimoto K. Intracordal injection of basic fibroblast growth factor in 100 cases of vocal fold atrophy and scar. Laryngoscope. 2021 Sep;131(9):2059-2064. doi: 10.1002/lary.29200.
Pierri IG, Bueno da Fonseca AR, Mendes Tavares EL, Martins RHG. Sulcus vocalis: clinical and surgical aspects. J Voice. 2023 Oct 28:S0892-1997(23)00277-1. doi: 10.1016/j.jvoice.2023.09.005.
Medeiros N, Castro MEM, van Lith-Bijl JT, Desuter GRR. A systematic review on surgical treatments for sulcus vocalis and vocal fold scar. Laryngoscope. 2022 Apr;132(4):822-830. doi: 10.1002/lary.29665.
Hirano S. Current treatment of vocal fold scarring. Curr Opin Otolaryngol Head Neck Surg. 2005 Jun;13(3):143-7. doi: 10.1097/01.moo.0000162261.49739.b7.
Hantzakos A, Dikkers FG, Giovanni A, Benninger MS, Remacle M, Sjögren EV. et al. Vocal fold scars: a common classification proposal by the American Laryngological Association and European Laryngological Society. Eur Arch Otorhinolaryngol. 2019 Aug;276(8):2289-2292. doi: 10.1007/s00405-019-05489-3.
Suresh A, Balouch B, Martha VV, Sataloff RT. Laryngeal applications of platelet rich plasma and platelet poor plasma: a systematic review. J Voice. 2024 Jan;38(1):248.e1-248.e13. doi: 10.1016/j.jvoice.2021.07.007.
Welham NV, Choi SH, Dailey SH, Ford CN, Jiang JJ, Bless DM. Prospective multi-arm evaluation of surgical treatments for vocal fold scar and pathologic sulcus vocalis. Laryngoscope. 2011 Jun;121(6):1252-60. doi: 10.1002/lary.21780.
Zagzoog FH, Bukhari M, Almohizea MI, Almothahbi AS. Efficacy of platelet-rich plasma (PRP) in benign vocal fold lesions: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2024 Jan;281(1):13-21. doi: 10.1007/s00405-023-08226-z.
Dailey SH, Ford CN. Surgical management of sulcus voca- lis and vocal fold scarring. Otolaryngol Clin North Am. 2006 Feb;39(1):23-42. doi: 10.1016/j.otc.2005.10.012.
Mallur PS, Rosen CA. Vocal fold injection: review of indications, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol. 2010 Dec;3(4):177-82. doi: 10.3342/ceo.2010.3.4.177.
Mackay G, Allen J. Platelet rich plasma injection of the vocal folds in benign vocal pathologies. Eur Arch Otorhinolaryngol. 2024 Oct;281(10):5419-5428. doi: 10.1007/s00405-024-08824-5.
Mackay G, Allen J. Platelet-rich plasma applications in the larynx: snake oil or stupendous? Curr Opin Otolaryngol Head Neck Surg. 2024 Dec 1;32(6):374-382. doi: 10.1097/MOO.0000000000001019.
Hirano S, Kawamoto A, Tateya I, Mizuta M, Kishimoto Y, Hiwatashi N. et al (2018) A phase I/II exploratory clinical trial for intracordal injection of recombinant hepatocyte growth factor for vocal fold scar and sulcus. J Tissue Eng Regen Med. 2018 Apr;12(4):1031-1038. doi: 10.1002/term.2603.
Nozawa M, Takahashi S, Kanazawa T, Kurakami K, Hasegawa T, Hirosaki M. et al. Intracordal injection therapy for vocal fold scarring: Steroid versus basic fibroblast growth factor. Laryngoscope Investig Otolaryngol. 2022 Sep 22;7(5):1465-1473. doi: 10.1002/lio2.881.
Erndt-Marino JD, Jimenez-Vergara AC, Diaz-Rodriguez P, Kulwatno J, Diaz-Quiroz JF, Thibeault S. et al. In vitro evaluation of a basic fibroblast growth factor-containing hydrogel toward vocal fold lamina propria scar treatment. J Biomed Mater Res B Appl Biomater. 2018 Apr;106(3):1258-1267. doi: 10.1002/jbm.b.33936.
Okui A, Konomi U, Kanazawa T, Komazawa D, Nakamura K, Matsushima K. et al. Therapeutic efficacy of basic fibroblast growth factor in patients with vocal fold atrophy. Laryngoscope. 2020 Dec;130(12):2847-2852. doi: 10.1002/lary.28541.
Li X, Wang H, Xu W. HGF and bFGF secreted by adipose-derived mesenchymal stem cells revert the fibroblast phenotype caused by vocal fold injury in a rat model. J Voice. 2022 Sep;36(5):622-629. doi: 10.1016/j.jvoice.2020.08.023
Hiwatashi N, Bing R, Kraja I, Branski RC. Mesenchymal stem cells have antifibrotic effects on transforming growth factor-β1-stimulated vocal fold fibroblasts. Laryngoscope. 2017 Jan;127(1):E35-E41. doi: 10.1002/lary.26121.
Hertegård S, Nagubothu SR, Malmström E, LeBlanc K. Treatment of vocal fold scarring with autologous bone marrow-derived human mesenchymal stromal cells—first phase I/II human clinical study. Stem Cell Res Ther. 2020 Mar 20;11(1):128. doi: 10.1186/s13287-020-01632-8.
van der Woerd B, O'Dell K, Castellanos CX, Bhatt N, Benssousan Y, Reddy NK. et al. Safety of platelet-rich plasma subepithelial infusion for vocal fold scar, sulcus, and atrophy. Laryngoscope. 2023 Mar;133(3):647-653. doi: 10.1002/lary.30288.
Woo P, Murry T. Short-term voice improvement after repeated office-based platelet-rich plasma PRP injection in patients with vocal fold scar, sulcus, and atrophy. J Voice. 2023 Jul;37(4):621-628. doi: 10.1016/j.jvoice.2021.02.022.
Woo SH, Jeong HS, Kim JP, Koh EH, Lee SU, Jin SM. et al. Favorable vocal fold wound healing induced by platelet-rich plasma injection. Clin Exp Otorhinolaryngol. 2014 Mar;7(1):47-52. doi: 10.3342/ceo.2014.7.1.47.
Özgürsoy SK, Tunçkaşık F, Tunçkaşık ME, Akıncıoğlu E, Doğan H, Beriat GK. Histopathologic evaluation of hyaluronic acid and plasma-rich platelet injection into rabbit vocal cords: an experimental study. Turk Arch Otorhinolaryngol. 2018 Mar;56(1):30-35. doi: 10.5152/tao.2018.2942.
Woo P. Platelet-rich plasma in treatment of scar, atrophy, and sulcus: short- and long-term results. Laryngoscope Investig Otolaryngol. 2023 Sep 5;8(5):1304-1311. doi: 10.1002/lio2.1143.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Joana Freitas Rebelo, Eugénia Castro, Mónica Teixeira, Catarina Pinto, Nuno Medeiros, Leandro Ribeiro, Pedro Oliveira
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
