A precricoid swelling in a patient treated with Teflon injection in the vocal fold after idiopathic left vocal fold palsy

Migration of Cymetra After Vocal Fold Injection for Laryngeal Paralysis

Injection laryngoplasty is a common operative technique used in the management of unilateral vocal fold paralysis. Cymetra is a micronized particulate injectable form of acellular human dermis that is commonly used for vocal cord medialization procedures. We report migration of an intracordal bolus of Cymetra into the medial wall of the pyriform sinus. Histopathology from endoscopic resection of the migrated Cymetra demonstrated a localized foreign body reaction with characteristic giant cells. Specific anatomic considerations through cadaveric laryngeal dissection are presented to demonstrate the likely pathway of intralaryngeal bolus migration.

Injection laryngoplasty

After a nearly a century of development, augmentation of laryngeal tissue through injection remains as complex a procedure as it was in the earlier part of the century. Initially, the number of surgeons performing injection laryngoplasty was limited since the technique of injection was thought to be difficult and the selection of cases was thought to require the judgment of an accomplished laryngologist. Performing successful injection laryngoplasty does in fact require an understanding of laryngeal anatomy and physiology, and the physical characteristics of the substance to be injected. In addition, the surgeon must be aware of potential host reactions to the injected material. Finally, the surgeon must have an understanding of the etiology and configuration of the glottic insufficiency, and keep in mind the goals of the procedure.

Histological study of injected autologous fascia in the paralyzed canine vocal fold

OBJECTIVE

Several methods have been used for the treatment of the unilateral paralyzed vocal fold. Teflon injections have been used extensively but not without complications. The ideal substance for injection is yet to be determined. Injected autologous fascia has been reported as a means of achieving glottic closure. In review of the literature, there are no long-term results described using autologous fascia in this way. The purpose of this study was to examine the histological changes of the larynx after injection of autologous fascia into a paralyzed vocal fold.

STUDY DESIGN

A prospective study with the contralateral side of the larynx used as the control.

METHODS

Six adult dogs underwent severing of one of their recurrent laryngeal nerves. After the vocal folds were confirmed to be paralyzed by direct laryngoscopy, fascia lata that was harvested from the animal was minced and injected into the paralyzed vocal fold. The dogs were then killed at intervals ranging from 3 to 12 months and their larynges reviewed histologically.

RESULTS

The larynges revealed muscle atrophy of the vocal fold, which is consistent with denervation, but there was no evidence of persistent fascia. In addition, there was no evidence of reaction to the injected fascia. Special stains for collagen were also performed which showed no significant change from the non-injected vocal fold.

CONCLUSION

From this model, it is concluded that injected autologous minced fascia is not a good short- or long-term substance for vocal fold augmentation. Further study is warranted to confirm this observation.