Future outcomes and current limitations of injectable implants for vocal fold scarring.

Introduction: Vocal fold (VF) scarring poses a significant challenge. It is characterized by prolonged and often irreversible impairment of vocal function due to loss of pliability and disruption of the lamina propria's native extracellular matrix. Current treatments remain largely palliative, aiming to improve glottic closure rather than restore normal tissue biomechanics. As research deepens into the wound healing pathways and fibrotic mechanisms underlying scar formation, injectable therapies are emerging as approaches to modulate healing and restore vibratory function.

Areas covered: This review outlines the pathophysiology of VF scarring and evaluates emerging injectable strategies designed to restore tissue architecture and function. These include biomaterial-based implants, antifibrotic and pro-regenerative biologics, stem cell therapies, and advanced drug delivery systems. The translational challenges include anatomical constraints, delivery precision, animal models, immune compatibility, degradation kinetics, and the lack of standardized outcome measures.

Expert opinion: The review highlights the ongoing research on injections of implants for VF scarring that support biomechanical properties and modulate local tissue repair. However, further advanced and long-term studies, including clinical trials, are needed to fully elucidate their safety, efficacy, and toxicity profiles. In addition, their scalability and reproducibility within pharmaceutical manufacturing must be rigorously validated to support clinical translation.