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Transoral injection laryngoplasty with videostroboscopy

last modified on: Wed, 03/27/2024 - 20:47

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

Technique for injection laryngoplasty employing stroboscopy

see also protocol for: Vocal Cord Injection with Prolaryn Gel with Videostroboscopy (transoral); Vocal cord paralysis treated with in-clinic transoral Restylane injection laryngoplasty; Injection Laryngoplasty for Presbylaryngis (Video) with Case Example

instruments: Xomed-Treace Injection Tray; Injectable substances for injection laryngoplasty

nerve blocks: Superior Laryngeal Nerve Blocks Instruction Video; Glossopharyngeal nerve block (gag reflex, transoral vocal cord surgery)

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Initial transoral videostroboscopic view

benzonatate (100mg tabs) dissolved in mouth, topical 4% lidocaine dripped on vocal cords, followed by benzocaine spray (shown)

Curved Xomed-Treace Oro-Tracheal Injector

Video-stroboscobe for targetting injection
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Injection laryngoplasty (see video below)

      

video

Case History: 8 collagen injections over seven year period with gradually increasing interval between injections

                                                                4-year interval between last two injections

58 yo man with left laryngeal paralysis treated initially at another institution with thyroplasty (Feb 2003) improving his voice from aphonic (G3R0B3...) with marked improvement seen for only one week then deterioration rapidly to moderate dysphonia (G2R0B2A2S0) when seen at the U of Iowa Voice Clinic Sept 9 2003. Remainder of vocal followup and interventions listed below at the U of Iowa Voice Clinic

initial examination 09-09-03 moderately dysphonic G2R2B2A2S0

9-16-2003 Cymetra injection to L TVC (0.4cc) indirect mirror guided injection (1st collagen injection)

f/u 11-13-03 improved voicing

02-17-04 mildly dysphonia G1R0B1A1S0 prior to Cymetra injection to L TVC (0.7 cc) indirect mirror guided injection (2nd collagen injection)

f/u 04-09-04 good result from above for 5 weeks with vocal deterioration to G1R1B1A1S0

06-04-04 Cymetra injection to L TVC (0.7 cc) indirect mirror guided (3rd collagen injection)

08-24-04 mildly dysphonic G1R0B1A1S0 good result for 5 weeks with strong voice then weakening desiring Cymetra injection to L TVC (0.6cc) (4th collagen injection)

f/u 12-02-04 normal voice G0R0B0A0S0 reported rough voice for 2-3 weeks after 8-24-04 injection but normal voicing since

03-28-05 mildly dysphonic G1R0B1A0S0 with concurrent swallowing deterioration with voice over past weeks Cymetra injection to L TVC (0.7cc) (5th collagen injection)

f/u 6-16-05 reported normal voicing (and singing) for four weeks post injection but subsequent deterioration but with normal voice assessed through voice clinic G0R0B0A0S0

07-05-05 normal voice in am but vocal fatigue with afternoon dysphonia Cymetra injection to L TVC (0.6cc) (6th collagen injection)

f/u 9-29-05 normal voice G0R0B0A0S0

10-03-06 strong voice persisted  until 8-06 (13 months) Cymetra injection to L TVC (0.5cc instilled with estimated 0.1 cc extruded = 0.4 cc retained) (7th collagen injection)

f/u 1-09-07 normal voice

f/u 07-27-10 gradual slight decrement in voice over the past 12 months (good effect for  33 months) to G1R0B1A1S0 Zyderm II injection to L TVC (0.45 cc) (8th collagen injection)

f/u 08-23-10 phone call: voice strong "all body functions better with a good seal"