Early versus late injection medialization for unilateral vocal cord paralysis

TLDR

Early medialization is believed to create a more favorable vocal cord position for phonation that can be maintained by synkinetic reinnervation, unlike the lateralized position determined solely by reinnervation. The study aimed to determine whether early (≤6 months) versus late (>6 months) injection medialization laryngoplasty reduces the need for subsequent open‑neck reconstruction in patients with unilateral vocal cord paralysis. A retrospective chart review of 35 adults who received awake, transoral, paraglottic hyaluronic‑acid gel injection within one year of paralysis onset—after excluding those with recovery, active disease, insufficient follow‑up, or death—was conducted. Early injection medialization resulted in adequate voice and avoided open‑neck reconstruction in 62.5% of patients, whereas none of the late injection patients did so (P = .03), indicating early treatment lowers reconstruction rates. Published in Laryngoscope, 2010.

Abstract

Abstract Objectives: To evaluate whether the timing of early (≤6 months from time of nerve injury) vs. late (>6 months) injection medialization laryngoplasty impacts the need for subsequent open‐neck reconstruction to restore vocal function in patients with unilateral vocal cord paralysis. Study Design: Retrospective chart review. Methods: A total of 112 outpatient or hospitalized adults with dysphonia resulting from postsurgical or idiopathic unilateral vocal cord paralysis were identified who were injected as initial treatment within 1 year of onset of their paralysis. All subjects underwent awake, transoral, paraglottic injection with absorbable hyaluronic‐acid gel. Patients with documented recovery of vocal cord mobility (22), active disease directly affecting the recurrent laryngeal nerve (8), <3 months of follow‐up after injection (time for gel to be reabsorbed) (34), or deaths within 1 year after the onset of paralysis (13) were excluded, leaving a study population of 35 patients. Results: Twenty of 32 (62.5%) patients with early injection medialization maintained an adequate voice, obviating the need for open‐neck phonosurgical reconstruction; their follow‐up from onset of paralysis ranged from 4.0 to 41.8 months (mean 15.2). None of the three patients undergoing late injection (>6 months postparalysis) avoided phonosurgical reconstruction ( P = .03, χ 2 test). Conclusions: Patients receiving early injection medialization for vocal cord paralysis were less likely to require transcervical reconstruction. We believe that early medialization creates a more favorable vocal cord position for phonation that can be maintained by synkinetic reinnervation, in contrast to the final position of a lateralized vocal cord being determined solely by reinnervation. Laryngoscope, 2010