Evaluating the timing of injection laryngoplasty for vocal fold paralysis in an attempt to avoid future type 1 thyroplasty.
OBJECTIVE
To determine whether immediate (less than 3 months from time of nerve injury), early (from 3 to 6 months from time of nerve injury) or late (more than 6 months from time of nerve injury) vocal fold injection influences the long-term outcomes for patients with permanent unilateral vocal fold paralysis.


METHODS
A total of 250 patients with documented unilateral vocal fold paralysis were identified in this retrospective chart review. 66 patients met the inclusion criteria, having undergone awake trancervical injection with gelfoam™, collagen, perlane™ or a combination. Patients with documented recovery of vocal fold mobility, or patients with less than one year of follow-up after the onset of paralysis were excluded. Patients were stratified into immediate (<3 months), early (3-6 months) and late (>6 months) groups denoting the time from suspected injury to injection. The need for open surgery as determined by a persistently immobile vocal fold with insufficient glottic closure following injection was the primary outcome.


RESULTS
1 out of 21 (4.8%) in the immediate group, 2 out of 17 (11.8%) in the early group and 20 out of 28 (71.4%) in the late group required type 1 thyroplasty procedures to restore glottic competence. There was significance when comparing late injection to both early and immediate injection (p < 0.001). No statistically significant differences were seen when comparing the number of injections needed to restore glottic competence.


CONCLUSIONS
This 10-year longitudinal assessment revealed that early medialization of a permanent paralyzed, abducted vocal fold with a temporary material appears to diminish the likelihood of requiring permanent laryngeal framework surgery.
Department of Otolaryngology - Head & Neck Surgery, McGill University, 687 Pine Ave, West, Montreal, QC, H3A 1A1, Canada. Yazeed.alghonaim@gmail.com.
Yazeed
Y
Alghonaim
Michael
M
Roskies
Karen
K
Kost
Jonathan
J
Young
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000008:administration & dosage*; D003094:Collagen / Q000008:administration & dosage*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D015552:Injections, Intralesional; D058753:Laryngoplasty; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D013997:Time Factors; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
D001672:Biocompatible Materials; C502935:Perlane; D006820:Hyaluronic Acid; D003094:Collagen