return to: Injection Laryngoplasty for Vocal Fold Paralysis and Glottic Incompetence

Transnasal Endoscopic Vocal Fold Augmentation: The indications for transnasal fiberoptic vocal cord injection are the same as for vocal cord injection by the percutaneous or transoral route. In some cases, this technique may be more readily tolerated by patients who would not be candidates for the other injection techniques.

Instruments: A transnasal endoscope designed for in-office esophagoscopy with an outer diameter of 5.1mm is utilized. Air/water insufflation and suction are available with this instrument but are not required for the procedure. The injection system that we  use is the  Microvasive "interject" esophageal sclerotherapy needle. The system is available in 23 or 25 gauge needle sizes.

1. Topical and Nasal Anesthesia
   1. Before introduction of the endoscope, we advocate nasal administration of atomized 1:1 mixture of 4% lidocaine and oxymetazoline. 
   2. Pledgets soaked in 4% lidocaine/oxymetazoline may be placed into the nasal cavity for 5-10 minutes to obtain further nasal analgesia and decongestion.
   3. The patient next swishes and gargles with 5 mL of 2% viscous lidocaine.
   4. Topical anesthesia of the vocal folds is obtained by spraying the larynx with 2-3 mL of 4% lidocaine, delivered under direct visualization through a catheter placed into the endoscope port.
2. Injection
   1. In a clinic suite, the operating endoscope is passed transnasally to view the larynx. The retractable needle and catheter system is passed through the port and is visualized at the tip of the endoscope, a distance of 4cm from the end of the endoscope.
   2. We recommend injecting lateral to the contact surface of the vocal fold at the greatest area of concavity, deep into the thryroarytenoid muscle under direct visualization. (The surgeon controls the endoscope, and an assistant manages the injection needle and catheter.)

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