Efficacy and safety of acute injection laryngoplasty for vocal cord paralysis following thoracic surgery

Authors

  • Evan M. Graboyes MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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  • Joseph P. Bradley MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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  • Bryan F. Meyers MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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  • Brian Nussenbaum MD

    Corresponding author
    1. Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
    • Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, St. Louis, MO 63110
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

The primary objective of this study was to evaluate the effectiveness and safety of injection laryngoplasty using a temporary injectable agent in the acute setting for patients with unilateral vocal cord paralysis following thoracic surgical procedures.

Study Design:

Retrospective consecutive case series in an academic institution.

Methods:

Inclusion criteria included patients acutely treated with injection laryngoplasty from January 1, 2006, to March 31, 2010, for a unilateral vocal cord paralysis that occurred after a thoracic surgical procedure (N = 20). All patients were injected with Radiesse Voice Gel using microlaryngoscopy technique.

Results:

The mean time to vocal cord injection from the time of thoracic surgery was 4.5 days. There was one operative-related complication of intraoperative bile reflux that caused a pneumonitis. Ninety percent of patients were recommended for strict nothing by mouth prior to injection. Of these, 94% were allowed an oral diet following injection, and 67% tolerated a regular diet. None of the patients required subsequent procedures for aspiration or dysphagia, and 25% required further intervention after discharge for persistent dysphonia. Patients with a known nerve transection had a higher rate of dysphonia requiring further surgical procedures than those who did not have a known nerve transection.

Conclusions:

Acute treatment of thoracic surgery-related unilateral vocal cord paralysis with injection laryngoplasty appears safe and effective at preventing postoperative aspiration pneumonia and improves swallowing function to allow resumption of an oral diet. A single injection is often the only required treatment.

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