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Transnasal Injection to Vocal Cord in COVID Era Using Negative Pressure Face Shield

Return to: Negative Pressure Face Shield (NPFS) for Transnasal Laryngoscopy to Mitigate Dispersion of Bioaerosol in COVID Era

Modified Operative Note

Procedure: Flexible transnasal laryngoscopy (VT scope) with topical anesthesia the larynx through the VT scope followed by Botox® (Botulinum neurotoxin) with sclerotherapy needle of 0.15 cc (3.75 units) the right TA muscle

Anesthesia: Left nostril sprayed with extender with 2 cc (2 separate installations) of 4% lidocaine 1% phenylephrine, 3 3 cc of 4% lidocaine instilled through the side-port of the VT scope through the endolarynx with direct visualization

Description of Procedure: Following identification the patient informed consent brief timeout and multiple consents including for use of the negative pressure shield, photo video, and the procedure he related he understood and wished to proceed.

He was positioned with the negative pressure face shield with total elapsed time from placement to removal of 7 minutes and 10seconds permitting the above-mentioned anesthesia to be followed by placement (with the VT scope straightened examining the posterior nasopharynx with placement of a primed 25-gauge sclerotherapy needle identified in the nasopharynx and retracted to allow for the placement the scope down towards the base of the tongue and the larynx and insinuating the 25-gauge sclerotherapy needle on the sheath with the assistant keeping it in a safe manner and advancing the scope and needle assembly into the midportion of the right membranous vocal fold and to which 0.15 cc (3.75 units) were instilled.

The sheath was removed back from the nasopharynx with the scope straightened and then a re-look at the larynx showing a small red dot where the mucosa had been transgressed for the injection with his affirmation he did feel the injection go in as he had on previous occasions expecting a favorable result.

It is noteworthy that the dilutions for the priming of the 25-gauge sclerotherapy needle included placement of 2 separate 1 cc aliquots of Botox at 25 units/cc (2.5 units per 0.1 cc that fill the entire dead space allowing for use of sterile saline to push this aliquot into the vocal folds to a volume of 0.15cc).

He tolerated the procedure well was observed in clinic and then discharged home with a follow-up as targeted in 3 months.