Current treatment of vocal fold scarring.
Current treatment of vocal fold scarring.
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DOI：
10.1097/01.moo.0000162261.49739.b7
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发表时间：
2005-06-01
影响因子：
1.6
通讯作者：
Hirano, Shigeru
中科院分区：
文献类型：
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作者：
Hirano, Shigeru
回顾目的：声带疤痕仍然是一个治疗挑战，其中最有问题的问题是组织学变化，这主要是导致声带粘膜粘弹性改变的原因。声带疤痕的最佳治疗方法尚未确定。为了恢复或再生受损的声带，研究固有层层结构的变化非常重要。组织工程和再生医学可能为声带疤痕的预防和治疗提供新策略。本文综述了这一领域的最新进展。最近的发现：组织学研究表明，透明质酸、纤连蛋白、核心蛋白聚糖和各种其他细胞外基质成分以及胶原蛋白可能有助于确定声带粘膜的振动特性。这些分子的变化被认为会影响疤痕声带的粘弹性。基于这些组织学发现，已经开发出创新方法，包括将透明质酸注射到受伤或有疤痕的声带中。最近取得进展的其他策略包括生长因子疗法和使用干细胞或成熟成纤维细胞的细胞疗法。这些新疗法的效果尚未在临床上得到充分证实，但这种再生医学策略似乎具有巨大的治疗潜力。总结：最近的研究揭示了与声带疤痕相关的详细组织学和流变学变化。基于这些发现，利用组织工程和再生医学在动物模型中开发了各种新的治疗策略。然而，尚未进行临床试验，需要更多的研究来确定最佳方式。
PURPOSE OF REVIEW: Vocal fold scarring still remains a therapeutic challenge, with the most problematic issue being the histologic changes that are primarily responsible for altering the viscoelasticity of the vocal fold mucosa. Optimal treatment for vocal fold scarring has not yet been established. To restore or regenerate damaged vocal folds, it is important to investigate the changes to the layer structure of the lamina propria. Tissue engineering and regenerative medicine may provide new strategies for the prevention and treatment of vocal fold scarring. Recent developments in this field are reviewed in the present article.RECENT FINDINGS: Histologic studies have revealed that hyaluronic acid, fibronectin, decorin, and various other extracellular matrix components, as well as collagen, may contribute to determining the vibratory properties of the vocal fold mucosa. Changes of these molecules are thought to affect the viscoelasticity of the scarred vocal folds. Based on such histologic findings, innovative approaches have been developed, including administration of hyaluronic acid into injured or scarred vocal folds. Other strategies that have recently shown advances include growth factor therapy and cell therapy using stem cells or mature fibroblasts. The effects of these new treatments have not fully been confirmed clinically, but there seems to be great therapeutic potential in such regenerative medical strategies.SUMMARY: Recent research has revealed the detailed histologic and rheologic changes related to vocal fold scarring. Based on these findings, various new therapeutic strategies have been developed in animal models using tissue engineering and regenerative medicine. However, no clinical trials have been performed, and more studies are necessary to establish the optimum modality.