Teflon Injection for Vocal Cord Paralys is after Intracranial Operation

Abstract

Vocal cord paralysis may follow intracranial operation if the vagus nerve is damaged intraoperatively. If the resulting laryngeal incompetence is severe, hoarseness, dysphagia, and aspiration may develop. This is often followed by a pneumonitis requiring chronic gastric tube feeding. Teflon vocal cord injection has been shown to restore the sphincteric action of the larynx and enable patients to phonate and swallow properly again. Nine patients underwent this procedure for chronic aspiration and hoarseness. All had vagus injury attributable to antecedent intracranial operation, and all experienced relief of their symptoms with only minor complications. Teflon vocal cord injection is advocated as a safe, effective means of managing patients with aspiration and dysphagia secondary to vagus nerve injury.

The role of glottal gap in predicting aspiration in patients with unilateral vocal paralysis

“…In 1998, Heller et al. 18 reported that an intracordal Teflon injection appeared to relieve aspiration for high vagal paralysis following intracranial surgery. However, Teflon injections, complicated with foreign body inflammation and granuloma, have not often been performed in recent years 19 .…”

Dysphagia Outcomes Following Surgical Management of Unilateral Vocal Fold Immobility: A Systematic Review and Meta‐analysis

“…Studies of LF procedures cited rates of diet liberation ranging from 69% to 75%, 19,22 while studies of IL had rates ranging from 70% to 100%. 34,36,37,40,41 Patient-reported dysphagia outcome measures were more variable for LF and IL. In studies that attempted to compare outcomes between LF and IL procedures, 12,23,43 there were in general no significant differences in outcomes shortly following surgery.…”

“…Thirteen studies had sufficient data to be in the quantitative analysis of complications. 14,17,20,23,25,[31][32][33][34][35][36][37][38] The overall estimated complication rate (major and minor) was 10% (95% CI, 6%,14%). When stratified by procedure, the pooled estimated complication rate (major and minor) was 7% (95% CI, 2%-13%) for IL (Figure 2) and 15% (95% CI, 10%-20%) for LF surgery (Figure 3).…”

“…Eleven studies had sufficient data to be in the quantitative analysis of treatment success, which encompassed 293 subjects/medialization procedures. 19,25,27,[31][32][33][34][35][39][40][41] Only studies that reported subject-level outcome data stratified by procedure were included. An analysis of dysphagia outcomes from LR procedures could not be performed because just 7 subjects with dysphagia underwent LR in the studies.…”

“…Nine studies noted UVFI outcomes related to a variety of sources (central, high vagal, and idiopathic), although the recurrent nerve was typically the most common site of injury in those cohorts. Three relatively small studies 22,34,45 evaluated outcomes of high vagal or central injuries only. Additionally, 3 studies 19,32,40 mentioned that patients with high vagal nerve, multiple cranial neuropathies, or central insults and UVFI had worse symptoms and outcomes after medialization procedures than those with recurrent laryngeal nerve injuries; however, this difference was not apparent by comparison of pooled outcomes among studies where, as stated previously, outcomes were generally positive for all.…”