Double-bend needle modification for transthyrohyoid vocal fold injection

Authors

  • Jihad Achkar MD,

    1. Division of Laryngology, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
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  • Phillip Song MD,

    1. Division of Laryngology, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
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  • Jennifer Andrus MD, FACS,

    1. Department of Otolaryngology–Head and Neck Surgery, Billings Clinic, Billings, Montana, U.S.A
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  • Ramon Franco Jr. MD

    Corresponding author
    1. Division of Laryngology, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
    • Division of Laryngology, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114-3096
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  • This work was performed at the Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Our objective was to describe an injection needle modification for awake in-office vocal fold injections through a percutaneous transthyrohyoid approach. Two separate 45° angle bends are created at the hub and 1 cm from the needle tip of a 25-gauge, 1.5-inch needle. After adequate endolaryngeal anesthesia, the needle is passed via the thyrohyoid membrane into the airway. The needle tip is at a 90° angle to the syringe, providing access to the entire vocal fold surface, regardless of chin position or thyroid cartilage angulation. The bend at 1 cm also serves as a marker to measure the depth of the needle within the soft tissue. The double-bend needle modification allows for complete access to the entire length of the true vocal fold in one pass as well as a marker to measure depth of the needle in the tissue. Limitations may include bleeding from the injection site, insufficient needle length in patients with a long anterior-posterior dimension of the larynx, and potential difficulty passing a needle through a calcified thyrohyoid membrane. Laryngoscope, 2012

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