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.