Point-Touch Vocal Fold Injection
The purpose of this vocal fold injection technique is to deliver a drug (e.g., Botox) or augmentation material (e.g., collagen) into the vocal fold, usually the vocal fold musculature. The drug is intended to have a physiologic effect on the muscle. The augmentation material is delivered into the vocal fold musculature to medialize the vocal fold for better vocal fold closure during phonation (injection laryngoplasty). This technique is performed entirely submucosally; the needle never enters the airway.
Indications/Contraindications
Injection of any therapeutic substance into the vocal fold might be used: botulinum toxin for laryngeal neurologic disorders, such as adductor type spasmodic dysphonia, cidofovir for recurrent respiratory papillomatosis, steroids for inflammatory disorders of the lamina propria, or any other medication.
Injection of a filler (e.g., collagen, Radiesse, Gelfoam) is performed to improve glottal insufficiency caused by vocal fold paralysis, paresis, atrophy, or other causes.
Contraindications might include a known allergy to the injectable, a strong concern for bleeding risk, or airway obstruction in the case of an already narrow glottis.
In the Clinical Setting
Key Points
Careful assessment and marking of external laryngeal landmarks (point) and tactile feedback (touch) permit accurate vocal fold injection without electromyography.
The needle tip may be visualized via flexible fiberoptic laryngoscopy, for visual feedback of placement and augmentation results.
The neck skin where the needle will be placed can be anesthetized with lidocaine minutes before the injection.
Pitfalls
Inadequate neck extension or indistinct cartilage landmarks may reduce injection accuracy.
Penetration and injection into the laryngeal or tracheal lumen will produce coughing and aspiration of injectate.
Superficial injection in a sub-epithelial plane produces an irregular vocal fold edge and can cause pain and dysphonia until the injectate dissipates.
From a Technical Perspective
Key Points
Visualization of the larynx from above in the laboratory will mimic the endoscopic view obtained in the clinical setting.
As the needle is placed into the larynx, careful visual observation of the submucosally placed needle tip will help to accelerate the learning curve for accurate injection.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
