Clark Rosen, MD is a consultant and has received honoraria from Bioform corporation for speaking; and Gregory Postma, MD, Blake Simpson, MD, Lucian Sulica, MD, and Milan Amin, MD have received honoraria from Bioform corporation for speaking.
Current practice in injection augmentation of the vocal folds: Indications, treatment principles, techniques, and complications
Article first published online: 8 DEC 2009
Copyright © 2009 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 120, Issue 2, pages 319–325, February 2010
How to Cite
Sulica, L., Rosen, C. A., Postma, G. N., Simpson, B., Amin, M., Courey, M. and Merati, A. (2010), Current practice in injection augmentation of the vocal folds: Indications, treatment principles, techniques, and complications. The Laryngoscope, 120: 319–325. doi: 10.1002/lary.20737
- Issue published online: 20 JAN 2010
- Article first published online: 8 DEC 2009
- Manuscript Accepted: 27 AUG 2009
- Manuscript Revised: 24 AUG 2009
- Manuscript Received: 24 MAY 2009
- Vocal fold;
- vocal cord;
- vocal fold injection;
- injection augmentation;
- vocal fold paralysis;
- vocal cord paralysis;
- laryngeal paralysis;
- vocal fold paresis;
- vocal fold scar;
- focal fold atrophy;
- glottic insufficiency;
To identify contemporary indications, treatment principles, technique, injection materials, complications, and success rates of vocal fold injection augmentation.
Multi-institutional retrospective review.
Records of patients undergoing injection augmentation at seven university medical centers from July 2007 through June 2008 were reviewed for information regarding diagnosis, unilateral or bilateral injection, route of injection, anesthesia, treatment site (office or operating room), material used, reason for technique selected, and technical success.
In 12 months, 460 injections were performed, 236 (51%) in awake, unsedated patients, and 224 (49%) under general anesthesia. Indications included vocal fold paralysis (248; 54%), paresis (97; 21%), atrophy (68; 15%) and scar (47; 10%). Scar was more likely to be treated in the operating room (P = .000052). In awake patients, 112 (47%) injections were performed by transcricothyroid approach, 55 (23%) by peroral approach, 49 (21%) by transthyrohyoid membrane approach, and 20 (8%) by transthyroid cartilage approach. Neither technical success rate (99% vs. 97%) nor complication rate (3% vs. 2%) differed between awake and asleep techniques. The most common materials in the clinic setting were methylcellulose (35%), bovine collagen (28%), and calcium hydroxylapatite (26%); in the operating room these were calcium hydroxylapatite (36%) and methylcellulose (35%). Calcium hydroxylapatite was more likely to be used under general anesthesia (P = .019). Five-year data show that the use of injection in the awake patient rose from 11% to 43% from 2003 to 2008.
Injection augmentation remains a safe, effective, and clinically practical treatment with a high rate of success, whether performed in the awake or asleep patient. The rapid adoption of awake injection over the past 5 years speaks to its clinical utility. Complication rates are low and equivalent to those under general anesthesia. Otolaryngologists continue to use a variety of techniques and materials to treat a range of conditions of glottic insufficiency. Laryngoscope, 2010