Use of Injectable Hydroxyapatite in the Secondary Setting to Restore Glottic Competence after Partial Laryngectomy with Arytenoidectomy

Abstract

Hydroxyapatite cement is a calcium phosphate putty, approved by the US Food and Drug Administration, that solidifies in 20 minutes and gains bone-like stability after 4 to 6 hours. It has been used for craniofacial reconstruction, spinal stabilization, and ossicular reconstruction. This is the first report of use of injectable hydroxyapatite to rebuild soft and hard tissue defects of the larynx after partial laryngeal surgery. Hydroxyapatite was injected in 4 patients to address glottic incompetence after partial laryngectomy. The patients were dependent on tracheotomy and/or gastrostomy tubes. Some had failed prior corrective surgeries. All of the operations were performed endoscopically and gave immediate improvement of glottic incompetence. All 4 patients reported improved symptoms. Three were able to have gastrostomy tubes removed, 1 was decannulated, and 1 had improved voice. In conclusion, hydroxyapatite injection is a technically simple procedure to restore glottic competence that may obviate the need for an open procedure.

The effect of a photopolymerizable poly(ε-caprolactone-co-glycolide) matrix on the cement reactions of tetracalcium phosphate and tetracalcium phosphate–monocalcium phosphate monohydrate mixtures

“…Calcium phosphates (CPs) are being developed as bone cements for use in osseous sites and dental applications such as lling of bone defects, reconstruction of frontal sinus and craniofacial skeletal tissues and the repair of periodontal bone defects. [1][2][3][4] These calcium phosphate cements (CPCs) are based on a powder that upon mixing with an aqueous solution forms a mouldable or even an injectable paste, which sets in situ by the formation of a nano-apatitic phase. 5 The latter is comparable to the main mineral phase of bone which makes the CPCs not only highly biocompatible with bone and the surrounding so tissues but also bioactive.…”

Radiographic properties of injected calcium hydroxylapatite: potential false positive findings on positron emission tomography

“…Since that time, it has become increasingly popular in the treatment of unilateral vocal fold paralysis and vocal fold bowing 4 . It has also been used to treat glottic insufficiency and aspiration following partial laryngectomy 5 . While the functional outcome following injection is the subject of intense ongoing study, the ultimate fate of the injected paste is less well characterised.…”