title: Current practice in injection augmentation of the vocal folds: indications, treatment principles, techniques, and complications.
abstract: OBJECTIVE
  To identify contemporary indications, treatment principles, technique, injection materials, complications, and success rates of vocal fold injection augmentation.
  
  
  METHODS
  Multi-institutional retrospective review.
  
  
  METHODS
  Records of patients undergoing injection augmentation at seven university medical centers from July 2007 through June 2008 were reviewed for information regarding diagnosis, unilateral or bilateral injection, route of injection, anesthesia, treatment site (office or operating room), material used, reason for technique selected, and technical success.
  
  
  RESULTS
  In 12 months, 460 injections were performed, 236 (51%) in awake, unsedated patients, and 224 (49%) under general anesthesia. Indications included vocal fold paralysis (248; 54%), paresis (97; 21%), atrophy (68; 15%) and scar (47; 10%). Scar was more likely to be treated in the operating room (P = .000052). In awake patients, 112 (47%) injections were performed by transcricothyroid approach, 55 (23%) by peroral approach, 49 (21%) by transthyrohyoid membrane approach, and 20 (8%) by transthyroid cartilage approach. Neither technical success rate (99% vs. 97%) nor complication rate (3% vs. 2%) differed between awake and asleep techniques. The most common materials in the clinic setting were methylcellulose (35%), bovine collagen (28%), and calcium hydroxylapatite (26%); in the operating room these were calcium hydroxylapatite (36%) and methylcellulose (35%). Calcium hydroxylapatite was more likely to be used under general anesthesia (P = .019). Five-year data show that the use of injection in the awake patient rose from 11% to 43% from 2003 to 2008.
  
  
  CONCLUSIONS
  Injection augmentation remains a safe, effective, and clinically practical treatment with a high rate of success, whether performed in the awake or asleep patient. The rapid adoption of awake injection over the past 5 years speaks to its clinical utility. Complication rates are low and equivalent to those under general anesthesia. Otolaryngologists continue to use a variety of techniques and materials to treat a range of conditions of glottic insufficiency.
authors.affiliation: Department of Otorhinolaryngology, Weill Cornell Medical College, New York, New York 10021, USA. lus2005@med.cornell.edu
authors.forename: Lucian
authors.initials: L
authors.lastname: Sulica
authors.forename: Clark A
authors.initials: CA
authors.lastname: Rosen
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Postma
authors.forename: Blake
authors.initials: B
authors.lastname: Simpson
authors.forename: Milan
authors.initials: M
authors.lastname: Amin
authors.forename: Mark
authors.initials: M
authors.lastname: Courey
authors.forename: Albert
authors.initials: A
authors.lastname: Merati
mesh_terms: D000553:Ambulatory Care; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001284:Atrophy; D001672:Biocompatible Materials / Q000008:administration & dosage*; D002921:Cicatrix / Q000628:therapy; D006801:Humans; D007267:Injections / Q000379:methods; D009873:Operating Rooms; D014826:Vocal Cord Paralysis / Q000628:therapy*; D014827:Vocal Cords / Q000473:pathology
chemical_list: D001672:Biocompatible Materials