Comparison of outcomes and complications between awake and asleep injection laryngoplasty: A Case‐Control Study

Abstract

Both awake and asleep IL offer comparable VRQOL results. Although having the benefit of avoiding general anesthesia, IL in the awake patient has a slightly higher complication rate.

Vocal Fold Injection: Review of Indications, Techniques, and Materials for Augmentation

“…VFI in the awake setting has the distinct advantages of providing direct feedback of vocal fold closure and voice outcome during the injection, avoiding limitations of difficult exposure, and avoiding general anesthesia with its inherent risks and increased cost (4). Technical successes, as well as voice outcomes, as measured by standardized patient-based voice surveys, are similar to injection performed under general anesthesia when performed by an experienced laryngologist (4, 5). Patient selection is critical when choosing VFI in an awake patient; a cooperative, calm patient without a strong gag reflex is required for successful completion.…”

“…One concern about awake VFI lies in the relative decrease in needle control, leading to decrease in precision of injection. In fact, there is some evidence that minor complications are slightly increased in an in-office setting (5). In-office VFI encompasses percutaneous (trans-cricothryoid membrane, trans-thyroid cartilage, and trans-thyrohyoid membrane), per-oral, and trans-nasal endoscopic approaches.…”

Evaluating the timing of injection laryngoplasty for vocal fold paralysis in an attempt to avoid future type 1 thyroplasty

“…However, due to its ease of use and low risk and complication rate, early injection laryngoplasty under topical anesthetic provides an excellent therapeutic option for both patients and physician. Awake injection laryngoplasty produces a substantial improvement in voice quality as measured by the Voice-Related Quality of-Life (VRQOL) measure [7]. Moreover, injection laryngoplasty produced improvements in Glottal Function Index (GFI), GRBAS, Functional outcome swallowing scale (FOSS), and maximum phonation time measurements, which confirm the advantage of this technique in improving glottic competency [5].…”

Advances in office‐based diagnosis and treatment in laryngology

“…In general, it is difficult to augment only the area of the deficit in the office, especially if the deficit is extremely focal. This task requires great precision and frequently some subepithelial dissection, both of which make direct laryngoscopy the preferred technique when such delicacy is called for 71…”