title: Office-based vocal fold injection with the laryngeal introducer technique.
abstract: OBJECTIVE
  There are numerous techniques for awake laryngeal injection, each with its limitations and technical challenges. We demonstrate a modification to the thyrohyoid approach for injection that stabilizes needle introduction and allows for consistent placement in a wide variety of larynges.
  
  
  METHODS
  Retrospective review at a tertiary care institution.
  
  
  METHODS
  A retrospective review was performed of the charts for patients consecutively undergoing awake vocal fold injection laryngoplasty in 2013 for glottic insufficiency due to unilateral vocal fold paralysis, vocal fold atrophy, or sulcus vocalis using the laryngeal introducer technique. The consistency of needle placement, ease of technique, and patient tolerance was assessed. The technique utilizes a curved 1.5-inch 18-gauge needle as a laryngeal introducer through the thyroid notch. Laryngeal injection augmentation is then performed using a curved 3.5-inch 25-gauge spinal needle through the introducer.
  
  
  RESULTS
  Twenty-one patients were identified who underwent awake vocal fold injection laryngoplasty for glottic insufficiency. All 21 injections were successfully placed. Five of seven injections attempted by resident physicians were able to be completed without attending assistance. Patient experience data demonstrated good tolerance, with a preference for the awake procedure as compared to that performed under general anesthesia.
  
  
  CONCLUSIONS
  The laryngeal introducer technique is a novel way of performing awake laryngeal injections. It provides a high rate of success, the ability to be consistently performed by inexperienced clinicians, and is well tolerated by patients.
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Clary
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Milam
authors.forename: Mark S
authors.initials: MS
authors.lastname: Courey
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007267:Injections; D058753:Laryngoplasty / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009339:Needles; D009819:Office Visits; D012189:Retrospective Studies; D014827:Vocal Cords; D055815:Young Adult
keywords: Vocal fold injection; awake procedures; injection laryngoplasty; laryngeal injection; laryngeal introducer; office-based; thyrohyoid approach; vocal folds