Clin Exp Otorhinolaryngol.  2010 Mar;3(1):37-41.

Comparative Analysis of Efficiency of Injection Laryngoplasty Technique for with or without Neck Treatment Patients: A Transcartilaginous Approach Versus the Cricothyroid Approach

• Lee SW
• Kim JW
• Koh YW
• Shim SS
• Son YI

Abstract

OBJECTIVES
These days, the main injection laryngoplasty technique is cricothyroid (CT) approach. However, patients who have previously undergone other neck treatments, such as thyroidectomy or neck dissection have distorted anatomical landmark makes this approach more difficult. The aim of this study is to determined the efficiency of transcartilaginous (TC) approah as compared with CT approach for unilateral vocal fold paralysis patients, especially for previously neck treated patients.
METHODS
From March 2005 to February 2008, 137 consecutive injection laryngoplasties were performed in patients with unilateral glottic insufficiency. Percutaneous injection was performed under local anesthesia into the vocalis muscle, using disposable 25 G 4 cm long needles through the cricothyroid membrane or directly through the thyroid cartilage. Of the 137 patients, 124 completed acoustic, perceptual, stroboscopic, and subjective evaluations prior to the injection and at 3 months after the injection.
RESULTS
In the 124 patients, the CT and TC approaches were used in 94 and 30 patients, respectively. Acoustic and perceptual parameters (GRBAS, MPT, jitter, shimmer), voice handicap index, and grades of mucosal waves and glottic closure were significantly improved after the injection in both the CT and TC groups (P<0.05). Only two patients (6.6%) had penetration difficulties, because of ossification of the thyroid cartilage. The overall success rates of the CT and TC approaches were 86.2%, 93.3%, respectively. However, the success rate of the TC approach in patients who had previously undergone neck treatments was significantly higher than that of the CT approach (100% vs. 65% P<0.05).
CONCLUSION
Based on the preliminary results of this trial, injection laryngoplasty using a TC approach was an effective alternative to the CT approach, especially in patients who had previously undergone neck surgeries.

Keyword

Injection laryngoplasty; Thyroid cartilage; Vocal cord paralysis

MeSH Terms

Acoustics
Anesthesia, Local
Humans
Laryngeal Muscles
Laryngoplasty
Membranes
Neck
Neck Dissection
Needles
Paralysis
Thyroid Cartilage
Thyroidectomy
Vocal Cord Paralysis
Vocal Cords
Voice

Figure

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  Fig. 1 Demostration of approach direction of cricothyroid (CT) and transcartilaginous (TC) approach in a human cadaveric larynx. Note that direction of needle is parallel to the vocal fold in TC approach but is oblique in CT approach. Long black arrow means an approach direction of CT method. Short white arrow means an approach direction of TC method. VF: vocal fold; Sup: superior; Inf: inferior.

• 

  Fig. 2 The success rate of transcartilaginous (TC) approach was significantly higher than cricothyroid (CT) approach (100% vs. 65%) for revisional neck group. Primary neck means the groups of patients who didn't received the neck operation before. Revisional neck means the groups of patients who received the neck operation before.*significant differences between CT and TC approach group.

Reference

1. Kwon TK, Buckmire R. Injection laryngoplasty for management of unilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg. 2004; 12. 12(6):538–542. PMID: 15548914.

2. Dursun G, Boynukalin S, Ozgursoy OB, Coruh I. Long-term results of different treatment modalities for glottic insufficiency. Am J Otolaryngol. 2008; Jan–Feb. 29(1):7–12. PMID: 18061825.

3. Trask DK, Shellenberger DL, Hoffman HT. Transnasal, endoscopic vocal fold augmentation. Laryngoscope. 2005; 12. 115(12):2262–2265. PMID: 16369177.

4. O'Leary MA, Grillone GA. Injection laryngoplasty. Otolaryngol Clin North Am. 2006; 2. 39(1):43–54. PMID: 16469654.

5. Lee SW, Son YI, Kim CH, Lee JY, Kim SC, Koh YW. Voice outcomes of polyacrylamide hydrogel injection laryngoplasty. Laryngoscope. 2007; 10. 117(10):1871–1875. PMID: 17690620.

6. Jin SM, Park CY, Lee JK, Ban JH, Lee SH, Lee KC. Transcutaneous injection laryngoplasty through the cricothyroid space in the sitting position: anatomical information and technique. Eur Arch Otorhinolaryngol. 2008; 3. 265(3):313–319. PMID: 17899146.

7. Berke GS, Gerratt B, Kreiman J, Jackson K. Treatment of Parkinson hypophonia with percutaneous collagen augmentation. Laryngoscope. 1999; 8. 109(8):1295–1299. PMID: 10443836.

8. Rosen CA, Murry T. Voice handicap index in singers. J Voice. 2000; 9. 14(3):370–377. PMID: 11021504.

9. King JM, Simpson CB. Modern injection augmentation for glottic insufficiency. Curr Opin Otolaryngol Head Neck Surg. 2007; 6. 15(3):153–158. PMID: 17483682.

10. Lee SH, Kwon HJ, Choi HJ, Lee NH, Lee SJ, Jin SM. The singer's formant and speaker's ring resonance: a long-term average spectrum analysis. Clin Exp Otorhinolaryngol. 2008; 6. 1(2):92–96. PMID: 19434279.

11. Green DC, Berke GS, Ward PH, Gerratt BR. Point-touch technique of botulinum toxin injection for the treatment of spasmodic dysphonia. Ann Otol Rhinol Laryngol. 1992; 11. 101(11):883–887. PMID: 1444094.

12. Anderson TD, Mirza N. Immediate percutaneous medialization for acute vocal fold immobility with aspiration. Laryngoscope. 2001; 8. 111(8):1318–1321. PMID: 11568562.