Transthyroid Lamina Vocal Fold Injection Laryngoplasty
Transthyroid lamina vocal fold injection laryngoplasty is a procedure that provides soft-tissue augmentation to the vocal folds for treatment of glottic insufficiency. This procedure may be performed as an office-based technique using a flexible transnasal laryngoscope for guidance, or in the operating room with suspension laryngoscopy.
Indications/Contraindications
Glottic insufficiency resulting from presbylaryngis/bilateral vocal fold atrophy, vocal fold paralysis or paresis or a situation where a medialized vocal fold is desired.
Allergy to the selected injectable is a contraindication.
In the Clinical Setting
Key Points
This procedure is preferentially used for the management of vocal fold atrophy. The transthyroid lamina technique enables the surgeon to increase the functional mass of the thyroarytenoid (TA) muscle.
Micronized dermis is preferred for this technique as this substance can be instilled into the muscular space relatively easily. If it migrates into the superficial lamina propria, the negative effect is minimal.
Bilateral injections are commonly needed and present the challenge of doing on one side what was done on the other. Placing two needles into the TA at the start of the case helps with this, in that one can inject a portion of the alloplast into each and compare effects. One can always add material, not remove it.
Pitfalls
Counseling the patient that injections offer only a temporary solution is essential since injections will not offer a long-term effect.
The needle tip placement is essential for accurate delivery of the injectate. Over-injection of the infraglottic edge can cause hoarseness that will not resolve until the injectate resorbs. Note: some medialization of the infraglottic edge when combined with medialization of the vocal fold′s medial edge is advantageous for voicing.
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