Percutaneous injection laryngoplasty

Chhetri, Dinesh K.; Jamal, Nausheen

doi:10.1002/lary.24417

Cited by 36 publications

(40 citation statements)

References 16 publications

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“…Whereas material backing out was not observed in our testing, a better understanding of injection mechanics and the effects of needle orientation and material temperature characteristics might better inform clinical use of these materials. These materials vary in their resorption rate and viscosity, with HA being the least viscous material, easiest to inject, and becoming progressively more viscous and longer acting from CMC to CaHA . Our results identified that HA requires the least amount of force to complete the injection from start to finish.…”

Section: Discussionmentioning

confidence: 74%

Quantification of injection force mechanics during injection laryngoplasty

Pearson

Ortiz²,

Montelongo

et al. 2018

The Laryngoscope

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Objectives In‐office or operative injection laryngoplasty requires needle stability for accurate material placement. To date, no reports compare injection forces based on needle gauge, bends, length, or material type or temperature. We hypothesize these factors alter injection forces and could impact clinical use. Methods Swine larynges were placed in a compression testing machine. Syringes were affixed to a stabilizing crossbeam. Straight needles (25G 1.5‐inch; 27G 1.25‐inch; or 9.8‐inch malleable shaft 16G per oral with 24G tapered needle tip) were inserted into the swine vocal folds to simulate realistic tissue resistance pressure. Compressive loading was conducted at 40 mm/minute until steady‐state force was achieved. Tests were completed with calcium hydroxylapatite (CaHa), carboxymethylcellulose, and hyaluronic acid at various temperatures and CaHa with various bends in the needles (n = 3 per group, comparisons performed by two‐way analysis of variance (ANOVA), Tukey's post‐hoc). Results Needle size, shape, and temperature altered injection force. Steady‐state force was highest with the per‐oral needle at a mean of 44.55N compared to 26.44N and 29.77N in the 25G and 27G percutaneous needles, respectively (P < 0.001). Stiffness rate (initial increasing force vs. distance to initiate injection) ranged from 19.75N/mm (per oral) to 22.06N/mm (25G) to 24.56N/mm (27G), (P = 0.875). Adding multiple bends to the per‐oral needle increased stiffness rate to 24.99N/mm (P = 0.035), whereas the 25G needle stiffness rate remained unchanged (P = 0.941), with the stiffness rate decreasing in the 27G needle with increasing bends (P = 0.033). Increased temperature decreased injection forces across all materials. Conclusion Needle caliber, length, and bends impact steady‐state forces and stiffness rates during vocal fold injection. Level of Evidence NA Laryngoscope, 129:1060–1066, 2019

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Section: Discussionmentioning

confidence: 74%

Quantification of injection force mechanics during injection laryngoplasty

Pearson

Ortiz²,

Montelongo

et al. 2018

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…In particular, an accurate localization of the needle is very tricky, and most laryngologists identify the position of the needle tip indirectly by the distortion of vocal fold configuration. Finally, because of the above‐mentioned reasons, accurate localization requires a high level of experience, and there is a steep learning curve involved in mastering this technique . Also, there are several limitations from the perspective of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The conventional insertion area in VFI using the CT approach is 5 to 12 mm from the midline just below the inferior border of the thyroid cartilage . During VFI via CT approach without the device, the route of the needle tip might be ambiguous and usually is presumed by an anatomical imaginary line or a change of vocal fold configuration.…”

Section: Discussionmentioning

confidence: 99%

“…It also has accelerated the spread of office‐based VFI . Currently, some laryngologists favor the CT approach because the submucosal pathway has several advantages: a low complication rate, suitability as an office‐based procedure, and good patient compliance . However, despite these advantages, this approach has the inevitable limitation that precise localization of the needle tip is difficult because it utilizes the submucosal route .…”

Section: Introductionmentioning

confidence: 99%

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Real‐Time Light‐Guided Vocal Fold Injection: Ex Vivo Feasibility Study in a Canine Model

Cha¹,

Yang

et al. 2018

The Laryngoscope

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Objective The transcricothyroid (CT) membrane approach is a good option for office‐based vocal fold injection (VFI). However, because the needle tip is invisible during injection using the CT approach, precise localization requires a high level of experience, and mastering this approach involves a steep learning curve. To overcome current limitations, we conceptualized a novel technique: real‐time light‐guided VFI (RL‐VFI), which enables simultaneous VFI under direct visualization of the lighted needle tip. Herein, we aimed to verify the feasibility of RL‐VFI in cadaveric canine model, simulating the setting of office‐based VFI, as well as to explore its clinical usefulness. Study Design Animal study. Methods A customized prototype device was developed. It consisted of three parts: light source, controller, and injector. Light source comprised laser diodes of two wavelengths (635 nanometers [nm], red; 532 nm, green). Four types of injector were developed using 40‐mm needles of 23‐ and 25‐gauge and optic fibers of 50 and 100 μm. ex vivo canine larynx was prepared for the experiment. Flexible laryngoscopy system was used to examine canine vocal folds. Results Various routes from three insertion points (3 mm, 10 mm, and 17 mm from the midline) were validated using the device. Regardless of the injection routes, the location of the needle tip was accurately indicated by light. RL‐VFI was feasible under light guidance without difficulties. Moreover, precise and simultaneous re‐injection could be performed at the intended point using the device. Conclusion We introduced RL‐VFI using our customized prototype device in an ex vivo canine larynx, simulating the setting of office‐based VFI. Clinical application of RL‐VFI will improve safety and precision of CT approach, as well as expand its applications in laryngology. Level of Evidence NA. Laryngoscope, 129:935–942, 2019

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“…In 2014, Chhetri and Jamal reported their approach to percutaneous vocal fold injection via the transcricothyroid membrane (TCM) and transthyroid cartilage approaches with concurrent flexible transnasal endoscopic monitoring . These investigators identified that it was necessary to develop expertise in correlating external landmarks with internal laryngeal anatomy for these blind approaches and that a “certain learning curve” is needed to master this technique . For transcricothyroid injection, Clary et al similarly identified that “precise placement of the needle tip is more difficult to obtain and can require a significant level of experience.”…”

Section: Discussionmentioning

confidence: 99%