Evaluating Safety of Awake, Bilateral Injection Laryngoplasty for Bilateral Vocal Fold Atrophy
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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Cited by (7)
Intractable Bleeding Following an Awake Bedside Injection Laryngoplasty in a Patient on KVAD ECMO
2022, Journal of VoiceCitation Excerpt :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 AmericaCitation Excerpt :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.
Treatments for Age-related Vocal Atrophy: A Systematic Review
2023, LaryngoscopePrimary injection laryngoplasty after chordectomy for small glottic carcinomas
2023, European Archives of Oto-Rhino-Laryngology