Vocal Fold Medialization Techniques

Vocal Fold Medialization by Injection

• Vocal fold medialization by injection is a standard laryngeal rehabilitation procedure.
• This procedure works best when arytenoid fixation is not present and sufficient vocal fold structure remains for needle placement.
• Common injection materials are autologous fat and Cymetra.
• Cymetra provides good phonatory results lasting 6-12 months with minimal inflammation.
• Hyaluronic acid formulations (like Hylan B gel) are also favorable due to viscoelastic properties.
• Although not FDA-approved for laryngeal injections, collagen can be effective for vocal fold paralysis and other deficits.
• Collagen can result in greater tissue stiffness and less-than-satisfactory results due to inflammatory changes.
• PTFE paste (Polytef) is discouraged unless long-term survival is uncertain due to potential PTFE granuloma formation causing dysphonia and airway obstruction.
• Calcium hydroxyapatite (Radiesse) shows similar response to fat injections in voice quality and duration, but has been linked to foreign body granulomatous reactions, potential dysphonia, pain, and vocal cord erythema.
• Micro-excision of the injectable material may be necessary.
• Chronic inflammatory infiltrate with surrounding foreign body giant cells are observed histologically, making calcium hydroxyapatite use cautious.

Approaches to Vocal Fold Paralysis

• Transoral and percutaneous approaches improve vocal fold paralysis management.
• These procedures can be performed quickly and effectively in an office setting, with minimal patient discomfort.
• Immediate results are common.
• If vocal fold function recovery is likely, fat and PTFE injections are usually contraindicated, favouring alternative methods.
• Cymetra can be used temporarily.
• Percutaneous injections can be done without sedation.
• Flexible fiberoptic laryngoscopy is crucial for visualization and injection adequacy.
• Direct laryngoscopy is recommended if airway management is a concern.

Explore the process of vocal fold medialization by injection, a crucial procedure in laryngeal rehabilitation. Understand the materials used, including autologous fat, Cymetra, and collagen, along with their benefits and potential complications. This quiz covers the effectiveness of these techniques for improving vocal function.