Over-injection of autologus fat in the vocal fold: how to remove the excess?

Chordal injection of autologous fat is useful in treating incomplete closure of the glottis on phonation, because it is simple, uses an intraoral approach and is mostly effective. However, when excess fat is injected, the removal of the excess is generally much more difficult than the injection. A 48-year-old man underwent intrachordal injections of autologous fat twice bilaterally for vocal fold atrophy. He came to our hospital because his hoarseness became worse after every operation. Three-dimensional computed tomography revealed that a large amount of fat was injected in the bilateral subglottal and glottic regions. These findings indicated that his dysphonia was due mainly to the excessive injected fat, and removal of the fat was planned. Under local anesthesia, we partially removed the excess fat through a window made in the thyroid cartilage, without touching the vocal folds. The voice and laryngeal findings were monitored during the surgery according to fiber-stroboscopic findings. Postoperatively, a significant improvement was seen in the voice and vibration of the vocal folds, although the results were not completely satisfactory.