Percutaneous injection laryngoplasty in the management of acute vocal fold paralysis

Abstract

Percutaneous injection laryngoplasty is a viable option for immediate rehabilitation of acute vocal fold paralysis, and can be performed in the inpatient setting. With dysphagia and aspiration secondary to multiple cranial nerve palsies, medialization of the paralyzed cord alone may be insufficient to restore safe oral alimentation.

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

“…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]. Bhattacharyya et al compared early and late vocal fold medialization for vocal fold paralysis following thoracic procedures and found a significantly reduced risk of post-injection pneumonia and length of hospital stay for the early injected group [8].…”

“…The optimal time and method of vocal fold paralysis management is controversial. Factors contributing to the controversy include uncertainty regarding the possible return of function, and concern about the irreversibility of some procedures [5]. Initial treatment options for UVFP include temporary vocal fold injection medialization, voice therapy, or observation for spontaneous return of function.…”

Transnasal Injection Laryngoplasty

“…12,13 In these approaches, no external incision is made, and the procedure is performed either under pure local anesthesia or under local anesthesia with sedation. It is a minimally invasive procedure that can be performed as an office procedure with minimal complications.…”

“…9 The limited morbidity of injection laryngoplasty under local anesthesia, partially attributed to scientific advances, has revolutionized awake injection laryngoplasty as a common practice among laryngologists and has promoted early intervention in patients with glottic incompetence. 12,13 As such, the transcutaneous and transoral injection techniques were conceptualized and adopted as office procedures performed under local anesthesia with moderate patient tolerance. The main advantage of these approaches in patients with unilateral vocal fold paralysis is lower airway protection as a result of the closure of glottic insufficiency.…”

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.…”