Outpatient‐based injection laryngoplasty for the management of unilateral vocal fold paralysis – clinical outcomes from a UK centre

Abstract

This is the largest case series of patients who had a local anaesthetic vocal cord injection with calcium hydroxylapaptite using the trans-thyrohyoid approach. Early data would suggest that the results are similar to injections performed under general anaesthesia when performed by an experienced laryngologist. VFI in a clinic-based (awake) setting has the distinct advantage of providing instant feedback of vocal fold closure and voice outcome during the procedure, avoiding general anaesthesia with its inherent risks and cost and also the limitations of difficult exposure.

The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency

“…In contrast to the presented effects, CaHA yields satisfactory results in medialization of the unaltered VF (e.g., in VF paresis) . Also, in the patients in our study with a pretreated scarred hemilarynx, injection of the nonaffected VF will result in projection of that side.…”

“…In contrast to the presented effects, CaHA yields satisfactory results in medialization of the unaltered VF (e.g., in VF paresis). 7,43,44 Also, in the patients in our study with a pretreated scarred hemilarynx, injection of the nonaffected VF will result in projection of that side. Therefore, we recommend this procedure as a subsequent therapy in cases where the pretreated VF with no or minimal lamina propria remaining will not accept any material and has a quite straight free VF margin.…”

Office‐based transnasal esophagoscopy biopsies for histological diagnosis of head and neck patients

“…The first reports on utilization of TNE in ENT practice were very encouraging in terms of image quality and patient acceptance, enabling the procedure to be performed under local anesthesia without sedation . As such, it provides the option of assessing UADT in the outpatient settings with the possibility of taking biopsies from suspicious areas and perform procedures such as secondary puncture of voice prosthesis or removal of foreign body, in addition to flexible CO 2 laser delivery and to guide injection thyroplasty . TNE also offers a good alternative in patients with large tumors or with multiple comorbidities in whom a general anesthetic would pose a risk to their general health.…”

In-Office Laryngeal Injection

“…Today, less than a decade since its use began again in earnest, multiple series attest to the broad use of office laryngeal injection for vocal fold augmentation, both domestically and abroad [2][3][4][5][6][7][8][9]. The technical and financial barriers to its use are the least of all of the office laryngeal procedures; the clinician may embark on office injection with already available equipment for little more than the cost of the injectable.…”

“…Its efficiency and tremendous utility makes it attractive to the otolaryngologist as well. Only the reluctance of third-party payers to cover the procedure, despite substantial and amply documented cost savings [2,7,9,10], has inhibited the use of the procedure by shifting costs to patients and their physicians.…”