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Awake Trancervical Injection Laryngoplasty – Thyrohyoid Membrane Approach

The procedure shown in this video is an awake transcervical injection laryngoplasty via a thyrohyoid membrane approach.

Editor Recruited By: Michael M. Johns III, MD

DOI: http://dx.doi.org/10.17797/elckgrc4zg

Vocal fold paralysis or paresis can result in glottic incompetence. This incomplete glottic closure can lead to a weak breathy voice as well as vocal fatigue or pain. Medialization and augmentation options include laryngeal framework surgery and injection laryngoplasty. Traditionally injections were performed via a direct laryngoscopy under anesthesia. Improvements in flexible nasolaryngoscope technology have allowed for awake transcervical approaches. The thyrohyoid approach for transcervical injection laryngoplasty was first described by Dr. Amin in 2006. It is now a widely used approach for in-office vocal fold augmentation. Amin MR. Thyrohyoid approach for vocal fold augmentation. Ann Otol Rhinol Laryngol. 2006 Sep;115(9):699-702.
Vocal fold paralysis/paresis, presbylarynx, glottic incompetence
airway obstruction, uncooperative patient
1.The patient should be sitting up in a âsniffingâ position. 2.Medications should be drawn up in advance.
A laryngoscopy with or without stroboscopy should be performed to identify glottic incompetence. Consider monitored anesthesia care for sick patients, especially those with cardiopulmonary disease.
The needle is inserted at the thyroid notch, aiming inferiorly and should enter the airway at the pediole of the epiglottis. If the thyroid notch cannot be identified, medialization can also be attempted via cricothyroid, trans-thyroid cartilage, and transoral techniques.
Using a thyrohyoid approach the needle can be seen in the airway allowing for better control of the injection location. However, for some patients the needle in the airway can be extremely stimulating despite local anesthesia. In addition, there can be extrusion of the injectate through the puncture sites.
The primary complication of this technique is laryngospasm. Other risks include bleeding and vocal fold hematoma. In addition, there are some patients who cannot tolerate an awake procedure and require sedation.
The primary complication of this technique is laryngospasm. Other risks include bleeding and vocal fold hematoma. In addition, there are some patients who cannot tolerate an awake procedure and require sedation.
none
1.Amin MR. Thyrohyoid approach for vocal fold augmentation. Ann Otol Rhinol Laryngol. 2006 Sep;115(9):699-702. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/17044543 2.Rees CJ, Mouadeb DA, Belafsky PC. Thyrohyoid vocal fold augmentation with calcium hydroxyapatite. Otolaryngol Head Neck Surg. 2008 Jun;138(6):743-6. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/18503847 3.Song PC, Sung CK, Franco RA Jr.Voice outcomes after endoscopic injection laryngoplasty with hyaluronic acid stabilized gel. Laryngoscope. 2010;120 Suppl 4:S199. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/21225797 4.Achkar J, Song P, Andrus J, Franco R Jr. Double-bend needle modification for transthyrohyoid vocal fold injection. Laryngoscope. 2012 Apr;122(4):865-7. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/22344556 5.Woo SH, Son YI, Lee SH, Park JJ, Kim JP. Comparative analysis on the efficiency of the injection laryngoplasty technique using calcium hydroxyapatite (CaHA): the thyrohyoid approach versus the cricothyroid approach. J Voice. 2013 Mar;27(2):236-41 http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/23280385 6.Gadkaree SK, Best SR, Walker C, Akst LM, Hillel AT. Patient Tolerance of Transoral versus Percutaneous ThyrohyoidOffice-Based InjectionLaryngoplasty: A Case-Controlled Study of 41 Patients. Clin Otolaryngol. 2015 Apr 10. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/25865128

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