Elsevier

Journal of Voice

Volume 35, Issue 5, September 2021, Pages 789-792
Journal of Voice

Evaluating Safety of Awake, Bilateral Injection Laryngoplasty for Bilateral Vocal Fold Atrophy

https://doi.org/10.1016/j.jvoice.2020.01.005Get rights and content

Summary

Objective

Office-based injection laryngoplasty (IL) has emerged as a useful procedure for otolaryngologists to correct glottic insufficiency while avoiding the costs and risks of general anesthesia. This is the first study focused on addressing the safety of bilateral IL for bilateral vocal fold (VF) atrophy.

Methods

Patient records were reviewed from Emory University Hospital Midtown during the period of 2005 to 2017. Patients who underwent awake, bilateral transthyrohyoid, transoral, transcricothyroid, or transthyroid cartilage IL for bilateral VF atrophy were analyzed. All procedures, including repeat injections, were bilateral. Complication rate was used to evaluate safety. Patients with vocal cord paralysis, paresis, scar, and sulcus were excluded from the study.

Results

Total 174 procedures met inclusion criteria. There were four complications, yielding a complication rate of 2.3%. Complications included aborted cases for difficult anatomy or poor patient tolerance, injection material not resorbing, and a VF hematoma. No patients had any airway emergencies or required admission to the hospital or evaluation in the emergency room.

Conclusions

This study illustrates a low complication rate for awake, bilateral IL in treating bilateral VF atrophy. This supports other studies that promote the safety of this procedure in the awake setting. Complications were associated with patient tolerance, unique anatomy, and in one case, anticoagulant medication. The low complication rate supports the conclusion that bilateral medialization IL is safe to perform in the office-based, awake setting.

Section snippets

INTRODUCTION

Since its introduction by Brunings1 in 1911, injection laryngoplasty has proven to be an efficacious procedure for correcting glottic insufficiency. Improvements in endoscopic imaging, injection approach, and injection materials in the past decade have led to more injection laryngoplasty procedures being performed with better accuracy and results.2 The indications for injection laryngoplasty have been well described in the literature and include several conditions that lead to loss of glottic

MATERIALS AND METHODS

After receiving approval from the Emory Institutional Review Board, the investigators began the retrospective review of records from patients with CPT codes 31599 (Z1471) and 31574 from Emory University Hospital Midtown during the period of 2005 to 2017. The original data collection resulted in 2,678 documented procedures. Patient charts were individually reviewed for cases of awake, bilateral injection laryngoplasty for bilateral vocal fold atrophy. After review of the charts, 139 individual

RESULTS

As demonstrated in Table 1, the patients included in the study were 76% male. Both male and female patients included in the study had average ages of 72 and 70, respectively. The most commonly used injection technique was the transthyrohyoid approach, which made up 88% of cases (Figure 1). All patients were injected in the office-based setting using local anesthesia.

The most commonly injected material was carboxymethylcellulose, which represented 42% of the procedures. Other materials used in

DISCUSSION

Awake injection laryngoplasty for treating glottic insufficiency has emerged as an important tool for the otolaryngologist. The data from this study and its reported complication rate of 2.3% support previous research that has examined the safety of injection laryngoplasty in the office setting.3,5, 6, 7, 8,11 In Sulica et al, the reported complication rate across their cohort of over 400 injections in the office-based and operating room with both bilateral and unilaterally injected patients

CONCLUSIONS

Overall, this study was successful in supporting the safety of awake, bilateral injection laryngoplasty in its treatment of bilateral vocal fold atrophy. Though due to its small size and retrospective nature, larger prospective studies would need to be performed to better comment on more of the nuances of this procedure's safety including what factors predispose patients to complications and if any specific material or method is more precarious. Having an excellent understanding of the anatomy

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  • Intractable Bleeding Following an Awake Bedside Injection Laryngoplasty in a Patient on KVAD ECMO

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    Awake bedside IL is considered a safe procedure. Multiple case series have documented rare complications (<3%) including superficial or over injection resulting in vibratory stiffness, dyspnea, globus, and cough – all self-resolving – and no instances of airway obstruction or hemorrhage.1,2,4 Significant bleeding has not been described as a major complication before in the literature.8

  • Hoarseness

    2021, Medical Clinics of North America
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    VF paralysis is treated with an awake, in-office injection medialization using multiple different approaches and materials.74 It is also useful for patients with other forms of glottic insufficiency, such as atrophy or paresis.75 Office-based intervention is well tolerated and the indications are broadening every day.

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