title: Double-bend needle modification for transthyrohyoid vocal fold injection.
abstract: Our objective was to describe an injection needle modification for awake in-office vocal fold injections through a percutaneous transthyrohyoid approach. Two separate 45° angle bends are created at the hub and 1 cm from the needle tip of a 25-gauge, 1.5-inch needle. After adequate endolaryngeal anesthesia, the needle is passed via the thyrohyoid membrane into the airway. The needle tip is at a 90° angle to the syringe, providing access to the entire vocal fold surface, regardless of chin position or thyroid cartilage angulation. The bend at 1 cm also serves as a marker to measure the depth of the needle within the soft tissue. The double-bend needle modification allows for complete access to the entire length of the true vocal fold in one pass as well as a marker to measure depth of the needle in the tissue. Limitations may include bleeding from the injection site, insufficient needle length in patients with a long anterior-posterior dimension of the larynx, and potential difficulty passing a needle through a calcified thyrohyoid membrane.
authors.affiliation: Division of Laryngology, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts 02114-3096, USA.
authors.forename: Jihad
authors.initials: J
authors.lastname: Achkar
authors.forename: Phillip
authors.initials: P
authors.lastname: Song
authors.forename: Jennifer
authors.initials: J
authors.lastname: Andrus
authors.forename: Ramon
authors.initials: R
authors.lastname: Franco
mesh_terms: D004867:Equipment Design; D006685:Hoarseness / Q000628:therapy*; D006801:Humans; D006928:Hyoid Bone; D007267:Injections; D009339:Needles; D013594:Syringes; D013957:Thyroid Cartilage; D014827:Vocal Cords