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Hoarseness or aspiration due to recurrent laryngeal nerve paralysis confront many patients with problems in their daily living. At our outpatient clinic, patients with unilateral laryngeal paralysis due to recurrent laryngeal nerve paralysis are treated by injecting atelocollagen (3% non crosslinked atelocollagen, Koken Co., Ltd.) into the vocal cords under endoscopic control, using a soft fiberscope. A single injection may not be effective, but a relatively satisfactory therapeutic result can be obtained after several repeated injections. In the present study, the tissue levels of atelocollagen in the vocal cords of 8 adult dogs were determined after intracordal injection to evaluate the efficacy of repeated injection therapy of atelocollagen. In addition, clinical data of 96 patients who were treated by this therapy at our outpatient clinic (57 males and 39 females with a mean age of 54.5 years) were assessed. Histological investigation indicated that relatively good amounts of atelocollagen were retained and accumulated in the vocal cord tissue after repeated injection, and that the tissue around the injection site showed no appreciable foreign body reaction. The clinical data showed that about half of the 96 patients had received repeated intracordal injection therapy of atelocollagen. Maximum phonation time (MPT) was determined in 75 of 96 patients. The preoperative mean MPT was 3.27 sec, whereas MPT after a single injection and after all injections increased to 6.67 and 7.16 sec, respectively. The difference was statistically significant (p &lt; 0.001), as assessed by the paired t-test. The results of this study indicate that besides being beneficial in accidents that result in recurrent laryngeal nerve paralysis, injection therapy with atelocollagen is of clinical value because the patient can receive repeated injections under endoscopic control at the outpatient clinic at reasonable intervals of time, and thus makes the therapy more convenient.

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Fundamental and Clinical Consideration of Repeated Intracordal Injection Therapy of Atelocollagen-A Histological Study of Canine Vocal Cords and a Review of Clinical Data of 96 Patients.