title: Early versus late injection medialization for unilateral vocal cord paralysis.
abstract: OBJECTIVE
  To evaluate whether the timing of early (≤6 months from time of nerve injury) vs. late (>6 months) injection medialization laryngoplasty impacts the need for subsequent open-neck reconstruction to restore vocal function in patients with unilateral vocal cord paralysis.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A total of 112 outpatient or hospitalized adults with dysphonia resulting from postsurgical or idiopathic unilateral vocal cord paralysis were identified who were injected as initial treatment within 1 year of onset of their paralysis. All subjects underwent awake, transoral, paraglottic injection with absorbable hyaluronic-acid gel. Patients with documented recovery of vocal cord mobility (22), active disease directly affecting the recurrent laryngeal nerve (8), <3 months of follow-up after injection (time for gel to be reabsorbed) (34), or deaths within 1 year after the onset of paralysis (13) were excluded, leaving a study population of 35 patients.
  
  
  RESULTS
  Twenty of 32 (62.5%) patients with early injection medialization maintained an adequate voice, obviating the need for open-neck phonosurgical reconstruction; their follow-up from onset of paralysis ranged from 4.0 to 41.8 months (mean 15.2). None of the three patients undergoing late injection (>6 months postparalysis) avoided phonosurgical reconstruction (P = .03, χ2 test).
  
  
  CONCLUSIONS
  Patients receiving early injection medialization for vocal cord paralysis were less likely to require transcervical reconstruction. We believe that early medialization creates a more favorable vocal cord position for phonation that can be maintained by synkinetic reinnervation, in contrast to the final position of a lateralized vocal cord being determined solely by reinnervation.
authors.affiliation: Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. afriedman3@partners.org
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Friedman
authors.forename: James A
authors.initials: JA
authors.lastname: Burns
authors.forename: James T
authors.initials: JT
authors.lastname: Heaton
authors.forename: Steven M
authors.initials: SM
authors.lastname: Zeitels
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005782:Gels / Q000008:administration & dosage; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage*; D014826:Vocal Cord Paralysis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
chemical_list: D005782:Gels; D055675:Viscosupplements; D006820:Hyaluronic Acid