Laryngeal framework regeneration

Abstract

The laryngeal framework consists of complex tissues including the thyroid cartilage, cricoid cartilage, and arytenoid cartilage. This framework contributes to protecting the inner aerodynamic tract from external impact and aids in maximizing vocal fold motion through intra-laryngeal muscular contraction. This structure is affected by malignant tumors, laryngeal trauma, congenital anomalies, stenosis, or intractable inflammatory diseases. Once this rigid structure is damaged, restoration of mechanical power sufficient to compensate for normal laryngeal function is quite difficult. Conventionally, laryngeal defects have been reconstructed with autologous tissues or flaps. These reconstructive surgeries, however, required donor tissue, skilled technique and multiple surgeries. Locoregional blood supply also had to be carefully considered to maintain living donor tissue. Tissue regeneration strategies for the laryngeal framework, therefore, have been sought to alleviate these problems. Recently, tissue engineering has attracted great attention as a means of recreating organs. There are three fundamental components in tissue engineering: Cells, scaffolds, and growth factors. Among these, scaffolds play a central role in laryngeal framework regeneration because great mechanical power is required immediately after surgery to maintain airway structure. In situ tissue engineering techniques, which allow in vivo regeneration of organs through the application of scaffolds, have shown recent advancement due to biomaterial innovations. In this chapter, current progress and limitations of laryngeal framework regeneration will be discussed. To date, intraluminal epithelialization and subepithelial tissue regeneration have achieved some success after laryngeal resection. Research into the next steps, including functional tissue regeneration and development of suitable scaffolds for children, is now warranted.