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

Abstract

ObjectivesTo determine whether immediate (less than 3 months from time of nerve injury), early (from 3 to 6 months from time of nerve injury) or late (more than 6 months from time of nerve injury) vocal fold injection influences the long-term outcomes for patients with permanent unilateral vocal fold paralysis.MethodsA total of 250 patients with documented unilateral vocal fold paralysis were identified in this retrospective chart review. 66 patients met the inclusion criteria, having undergone awake trancervical injection with gelfoam™, collagen, perlane™ or a combination. Patients with documented recovery of vocal fold mobility, or patients with less than one year of follow-up after the onset of paralysis were excluded. Patients were stratified into immediate (<3 months), early (3-6 months) and late (>6 months) groups denoting the time from suspected injury to injection. The need for open surgery as determined by a persistently immobile vocal fold with insufficient glottic closure following injection was the primary outcome.Results1 out of 21 (4.8%) in the immediate group, 2 out of 17 (11.8%) in the early group and 20 out of 28 (71.4%) in the late group required type 1 thyroplasty procedures to restore glottic competence. There was significance when comparing late injection to both early and immediate injection (p < 0.001). No statistically significant differences were seen when comparing the number of injections needed to restore glottic competence.ConclusionsThis 10-year longitudinal assessment revealed that early medialization of a permanent paralyzed, abducted vocal fold with a temporary material appears to diminish the likelihood of requiring permanent laryngeal framework surgery.

Early voice rehabilitation with injection laryngoplasty in patients with unilateral vocal cord palsy after thyroidectomy

“…In this regard, recent investigations have suggested that early postoperative management of VCP is advantageous [7,9,16]. Previous studies indicated that injection laryngoplasty using temporary injectable material in the acute postoperative period was safe and effective in preventing aspiration pneumonia in patients with VCP following thoracic surgery [8,17,18].…”

“…Friedman et al suggested that early medialization creates a more favorable vocal cord position for phonation, which can be maintained during synkinetic reinnervation [7]. Alghonaim et al reported that use of temporary material for early medialization of a permanently paralyzed, abducted vocal fold appeared to diminish the likelihood of requiring permanent laryngeal framework SD standard deviation, MPT maximal phonation time, NHR noise-to-harmonics ratio, GRBAS grade of hoarseness, roughness, breathiness, asthenia, and strain, VHI voice handicap index surgery [9]. Furthermore, a recent meta-analysis examining the treatment of unilateral vocal cord paresis or paralysis after thyroidectomy proved that early injection is more effective than late injection, as demonstrated by a lower effect size for likelihood of an unsatisfactory outcome in the early injection group [16].…”

“…Interestingly, recent analyses examining the timing of injection laryngoplasty have suggested that early intervention using temporary injection material facilitates favorable outcome and reduces the need for open surgical intervention, even when vocal cord immobility persists beyond the expected spontaneous neural recovery period [7][8][9]. These effects have been attributed to optimal synkinetic reinnervation occurring prior to absorption of the temporary injection material, leading to favorable vocal cord positioning for phonation [7].…”

Management of Unilateral Vocal Cord Palsy: Case Series with Review of Literature

“…Unilateral vocal cord palsy, if temporary, is known to recover completely by 9 to 12 months and can be aided by speech therapy and temporary medialization by injection laryngoplasty. In cases with permanent paralysis, attempts are directed at improving the voice, 3 Reiter and Brosch, 4 and Algonaim et al 5 have reported the mean age of their study cohort in the sixth decade of life, a decade more than our study. The difference in the age distribution between Indian and Western nations could be explained based on the higher life expectancy in the population of the affluent nations.…”

Our Experience of Medialization Thyroplasty with Freeze-Dried Cadaveric Human Fascia Lata in Unilateral True Vocal Cord Paralysis

“…In medialization laryngoplasty, a common surgical approach, the vocal fold is paralyzed using an external approach. However, this procedure is fully invasive and has significant complications, especially if the surgeon is inexperienced (11).…”