Inflammatory complications of vocal fold injection with hyaluronic acid: a multiinstitutional study

Abstract

Background/aim: This study aimed to assess the inflammatory adverse reactions of vocal fold injection laryngoplasty with hyaluronic acid. Materials and methods: This study was a retrospective chart review of patients who underwent vocal fold injection augmentation with HA injection from January 2005 to September 2016 in nine different institutions. Demographic data, indication for injection, injection techniques, types of injection material, settings of procedure, and complications were reviewed. The types of complication, onset time, and management of complications were also noted. Results: In all, 467 patients were identified. The majority of patients had been injected under general anesthesia (n = 382, 84.7%). For injection material, two different types of hyaluronic acid were used: hyaluronic acid alone or hyaluronic acid with dextranomer. Complications occurred in nine patients (1.9%). The majority of complications were inflammatory reactions (n = 7, 1.47%). Main symptoms were dysphonia and/or dyspnea with an onset of 0 h to 3 weeks after the hyaluronic acid injection. Three patients were hospitalized, one of which was also intubated and observed in the intensive care unit for 24 h. Systemic steroids and antibiotics were the main medical treatment in the majority of cases. There was no statistical difference in complication rates between patients who received hyaluronic acid and those who received hyaluronic acid with dextranomer (P = 0.220). Conclusion: Hyaluronic acid can be considered as a safe substance for the injection of vocal folds with a low risk of inflammatory reaction.

Fat Versus Hyaluronic Acid Injection Laryngoplasty for Unilateral Vocal Fold Paralysis: Efficacy and Results

“…None of the patients under study developed adverse effect due to injection in both groups. In contrary, Enver et al, (2021) detected inflammatory complications in 2% of cases injected with hyaluronic acid [19] . Zapanta et al, (2004) reported a case of laryngeal abscess after alloderm injection [20] .…”

Severe Airway Edema Following Calcium Hydroxylapatite (CaHA) Injection Augmentation

“…Seven in total (1.7%) developed inflammatory reactions. 5 Review of the literature also demonstrated an extra-thyroidal neck abscess thought to be secondary to extra laryngeal injection of CaHA into the superficial neck space. 6 One patient experienced anaphylaxis after CaHA injection 2 and another pulmonary embolism due to the foreign body.…”

The Long Term Results of Hyaluronic Acid/Dextranomer Injection Laryngoplasty in Unilateral Vocal Fold Paralysis

“…29 Complications associated with HA IL can be classified into 2 categories: technical problems, such as hematoma and submucosal injection, and inflammatory reactions caused by ischemic events, hypersensitivity reactions, and acute bacterial infections. 11 An animal study conducted to assess the safety profile of HA/D demonstrated minimal inflammatory reaction on histological examination of rabbit vocal folds 6 months after injection, with no foreign body reactions observed. 30 In one of the largest case series in the literature, Dominguez et al 29 reported an incidence of inflammatory reactions after HA IL of 3.8% (7 out of 186 patients).…”

“…Another case series that used HA/D and HA for IL reported side effects in 9 out of 476 patients (1.9%). 11 Of these patients, 2 experienced technical problems, while 7 experienced inflammatory reactions. In the current study, none of the patients experienced any side effects after IL.…”

“…[7][8][9] Another animal study reported that the viscoelastic properties of the HA/D-injected vocal fold were similar to those of healthy vocal folds. 10 In a recently conducted study, Enver et al 11 reported that no significant difference was found between the complication rates after HA and HA/D injection laryngoplasty.…”