Injection laryngoplasty for management of unilateral vocal fold paralysis

Abstract

Purpose of reviewThe purpose of this review is to provide an up-to-date review of injection laryngoplasty technique and currently available injectable materials in the management of unilateral vocal fold paralysis (UVP). Recent findingsMany new materials are currently available as substances for injection laryngoplasty. These materials have been developed along distinct of lines reasoning that address the inherent shortcomings of the previously available injectable substances, namely, poor tissue biocompatibility and poor persistence within the larynx. Accordingly, the past decade has seen heightened efforts toward developing implants with improved biocompatibility and longevity. The past year has witnessed publications reporting animal studies and, on occasion, human clinical trials involving the intralaryngeal injection of calcium hydroxyl-appetite, autologous fascia, particulate silicone and hyaluronic acid derivatives, and others, for managing glottic insufficiency. SummaryIn recent years, the application of injection laryngoplasty to unilateral vocal fold paralysis (UVP) has regained popularity. The technique of injection laryngoplasty has several appealing qualities including relative technical ease, low cost, and wide availability in many clinical settings. A growing number of injectable substances have been developed and tested in the clinical setting of glottic insufficiency. When used to manage unilateral vocal fold paralysis, however, injection laryngoplasty has one irrefutable shortcoming: an inability to address posterior glottic insufficiency. Therefore, while injection laryngoplasty technique becomes increasingly popular for vocal fold augmentation in cases vocal fold paresis, atrophy, and scarring, its role in the treatment of UVP should be limited to cases with an appropriate glottal defect. These techniques should be considered as part of a complimentary armamentarium with framework surgery.

The Use of Polydimethylsiloxane for Injection Laryngoplasty

“…Paraffin oil, as injected by Brüning, was soon abandoned due to migration, foreign body reaction, rejection, and recurrent inflammation [2]. Later in the 1950s the use of biological materials was recommended by Arnold, but autologous cartilage and bone flour appeared to be useless because of their rapid resorption [12].…”

“…It can most often be harvested in abundance and its viscoelastic characteristics are comparable to those of the vocal cord [2]. An overcorrection is proposed because of its partial resorption, but this is problematic because the rate of resorption differs from patient to patient.…”

“…In these patients injection laryngoplasty is a safe and easy method. Since its introduction 1911 by Brüning (cited as quoted in [1]), a range of substances such as paraffin, autologous fat tissue, fascia, gelatin, calcium hydroxylapatite, hyaluronan acid, and Teflon Ò has been tried and most of them were abandoned due to resorption, migration, or complications [2,3].…”

Our Experience of Medialization Thyroplasty with Freeze-Dried Cadaveric Human Fascia Lata in Unilateral True Vocal Cord Paralysis

“…According to recent reports, temporary vocal fold injection obviates the need for permanent medialization laryngoplasty or thyroplasty in comparison with only conservative management (8). Many injectable materials have been introduced with valuable characteristics, such as biocompatibility, lack of local tissue reaction or fibrosis, low cost, resistance to absorption or migration, and maintenance of viscoelasticity of the vocal cord (9).…”

“…Despite the benefits of vocal fold injection, laryngeal framework surgery remains the gold standard for the treatment of UVFP with favorable long-term outcomes (8). In medialization laryngoplasty, a common surgical approach, the vocal fold is paralyzed using an external approach.…”