Evaluating Safety of Awake, Bilateral Injection Laryngoplasty for Bilateral Vocal Fold Atrophy

  • Zachary Kelly
    Emory University School of Medicine, Atlanta, Georgia
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  • Anju K. Patel
    Department of Otolaryngology—Head and Neck Surgery, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia
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  • Adam M. Klein
    Address correspondence and reprint requests to Adam M. Klein, Emory Voice Center, Emory University Hospital Midtown, 550 Peachtree Street, Suite 9-4400, Atlanta 30308, GA.
    Department of Otolaryngology—Head and Neck Surgery, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia
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      Office-based injection laryngoplasty (IL) has emerged as a useful procedure for otolaryngologists to correct glottic insufficiency while avoiding the costs and risks of general anesthesia. This is the first study focused on addressing the safety of bilateral IL for bilateral vocal fold (VF) atrophy.


      Patient records were reviewed from Emory University Hospital Midtown during the period of 2005 to 2017. Patients who underwent awake, bilateral transthyrohyoid, transoral, transcricothyroid, or transthyroid cartilage IL for bilateral VF atrophy were analyzed. All procedures, including repeat injections, were bilateral. Complication rate was used to evaluate safety. Patients with vocal cord paralysis, paresis, scar, and sulcus were excluded from the study.


      Total 174 procedures met inclusion criteria. There were four complications, yielding a complication rate of 2.3%. Complications included aborted cases for difficult anatomy or poor patient tolerance, injection material not resorbing, and a VF hematoma. No patients had any airway emergencies or required admission to the hospital or evaluation in the emergency room.


      This study illustrates a low complication rate for awake, bilateral IL in treating bilateral VF atrophy. This supports other studies that promote the safety of this procedure in the awake setting. Complications were associated with patient tolerance, unique anatomy, and in one case, anticoagulant medication. The low complication rate supports the conclusion that bilateral medialization IL is safe to perform in the office-based, awake setting.

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