Summary
Objectives/Hypothesis
To report the rate and describe the characteristics and management of inflammatory
reactions following injection laryngoplasty with hyaluronic acid derivatives.
Study Design
Single institution, retrospective review.
Methods
Adult and pediatric patients who underwent injection laryngoplasty with hyaluronic
acid derivatives from 2013 to 2020 were identified. Demographics, indication for injection,
type and volume of injected material, and use of general anesthesia were obtained.
When a postoperative inflammatory response occurred, information regarding clinical
presentation, timing, and subsequent management was collected.
Results
A total of 464 patients who underwent 536 laryngeal injections with hyaluronic acid
derivatives were included. There were 365 adult patients (median age 62 years) who
underwent 431 injections and 99 pediatric patients (median age 2 years) who underwent
105 injections. The most common indications for injection were abnormal vocal fold
mobility (70.3%) and aspiration (83.8%) for adult and pediatric patients, respectively.
Juvéderm® was used in 449 cases (79.8% adult, 100% pediatric), and Restylane® was
used in the remaining adult cases (20.2%). Procedures were mostly performed under
general anesthesia (67.7% adult, 100% pediatric) with median injection volumes of
0.6 mL for adult and 0.3 mL for pediatric patients. An inflammatory reaction occurred
following 3 of 536 injections (0.6%), all utilizing Juvéderm®. All three patients
presented with stridor, dyspnea, and laryngeal edema within two days of injection.
Each patient was admitted for observation and successfully treated with intravenous
steroids and inhaled racemic epinephrine. One patient with comorbid pneumonia was
intubated and required concomitant treatment with broad-spectrum antibiotics.
Conclusions
Inflammatory reactions to hyaluronic acid derivatives used in injection laryngoplasty
are rare but represent significant patient morbidity and can be managed with anti-inflammatory
and airway stabilizing measures. Patients should be counseled appropriately regarding
the risks of injection laryngoplasty with hyaluronic acid derivatives.
Key Words
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Article info
Publication history
Published online: August 06, 2022
Accepted:
July 5,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
