orabase and Vocal-Cord-Paralysis

Topics: Abscess; Adipose Tissue; Adolescent; Anti-Bacterial Agents; Carboxymethylcellulose Sodium; Combined Modality Therapy; Drainage; Female; Humans; Injections, Intralesional; Laryngoscopy; Lipectomy; Surveys and Questionnaires; Transplantation, Autologous; Vocal Cord Paralysis; Voice Disorders; Voice Quality

Trial vocal fold injection (TVFI) is employed diagnostically for patients with subtle glottic insufficiency to explore potential for improvement. Clinical experience demonstrates the time to and length of peak benefit of the TVFI is variable. Previous studies collected data 4 weeks or more after TVFI. The aim of this study was to compare subjectively successful and unsuccessful TVFI patient groups. It is hypothesized that patients with subjectively reported success will also have significant improvements in Voice Handicap Index-10 (VHI-10), phase closure percentage, and aerodynamic measures 2 weeks after trial augmentation.. Subjects with glottic insufficiency were included in this retrospective review if they underwent office-based, per-oral vocal fold injection augmentation specifically for trial purposes. Patients were divided into "successful" and "unsuccessful" groups based on their subjective experience during the 2-week post-TVFI period. VHI-10, subjective report, phase closure evaluation using frame-by-frame analysis, and aerodynamic data were collected pre- and 2 weeks post-TVFI.. Of the subjects, 15 of 23 (65%) reported a successful subjective improvement of their symptom, whereas 8 (35%) were unsuccessful (only partial improvement or no improvement). The number of subjects with an improvement in VHI-10 by 5 or more points was not significantly different between groups. The number of subjects that demonstrated complete, long phase closure was significantly higher in the successful group (P = 0.021).. The understanding of how to more precisely determine the success of TVFI remains incomplete. Subjective improvement of successful TVFI was captured with basic clinical questioning, yet the VHI-10 was unable to confidently demonstrate this reported success 2 weeks after TVFI.

Topics: Adult; Aged; Aged, 80 and over; Carboxymethylcellulose Sodium; Disability Evaluation; Female; Humans; Injections; Male; Middle Aged; Phonation; Recovery of Function; Retrospective Studies; Time Factors; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice Disorders; Voice Quality

Ideal long-term vocal fold augmentation materials should be biocompatible, easily administered, allow tissue integration for long-term effect, and remain at the site of injection. A novel silk protein particle suspended in hyaluronic acid (Silk-HA) has been developed specifically for vocal fold augmentation to address this unmet need. This article presents the 6-month, preclinical findings of a canine vocal fold injection trial for Silk-HA.. Twelve beagle dogs were injected transorally in the lateral/deep aspect of their right thyroarytenoid muscles with 0.3 cc of Silk-HA or calcium hydroxylapatite in carboxymethyl cellulose (CaHA-CMC). The Silk-HA particle injectable was delivered via a custom catheter, whereas CaHA-CMC was delivered through a commercially available malleable needle. The six dogs from each material group were sacrificed 6 months from the injection date for the evaluation of implant longevity, immune response, and material migration.. Silk-HA provides immediate medialization of the right vocal fold, lasting for a minimum of 6 months in a canine model. Silk-HA and CaHA-CMC both demonstrate similar inflammatory responses. The Silk-HA was shown to remain without migration at the site of injection in all six canine subjects, whereas CaHA-CMC demonstrated migration in four of the six canines. In two canines implanted with CaHA-CMC, material was discovered to migrate to the retropharyngeal lymph nodes.. In a canine subject model, the Silk-HA material compares favorably in terms of longevity and immune response to CaHA-CMC. The lack of migration of the Silk-HA material demonstrates a promising potential for vocal fold injection in the clinic.. NA Laryngoscope, 129:1856-1862, 2019.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Dogs; Durapatite; Hyaluronic Acid; Injections, Intramuscular; Laryngeal Muscles; Models, Animal; Silk; Time Factors; Vocal Cord Paralysis; Vocal Cords

This study aims to assess the effect of vocal fold injection augmentation (IA) on subsequent medialization laryngoplasty (ML).. A retrospective cohort study with follow-up telephone survey was carried out.. Clinical records of patients with unilateral vocal fold paralysis or paresis (VFP) who underwent ML between April 2006 and March 2015 were reviewed. Patients who underwent IA before ML were compared with patients who did not, with respect to demographic information, symptoms, Voice Handicap Index-10 (VHI-10), etiology of VFP, and revision rate. Among patients undergoing IA, the effects of injection material and of interval from IA to ML on revision rate were assessed. Follow-up telephone surveys were conducted to evaluate long-term outcomes using VHI-10 and a condition-specific questionnaire.. One hundred thirty-five patients (70 male:65 female) with vocal fold paralysis (125) or paresis (10) underwent ML (96 left:39 right). Sixty-six (48.9%) patients underwent concurrent arytenoid adduction. Fourteen (10.4%) patients required revision. Fifty-six (41.5%) patients had prior IA; five (8.9%) patients underwent revision. Seventy-nine (58.5%) patients did not have IA; nine (11.4%) patients required revision (P = 0.78). Neither augmentation material nor length of interval between last IA and ML affected the revision rate (P = 1.00; P ≥ 0.11 for all tested intervals, respectively). No difference in follow-up VHI-10 score was found between patients who had IA before ML and patients who had not (P = 0.73).. IA does not appear to affect the revision rate or long-term outcome of subsequent ML.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carboxymethylcellulose Sodium; Disability Evaluation; Durapatite; Female; Health Care Surveys; Humans; Injections; Laryngoplasty; Male; Middle Aged; Patient Satisfaction; Recovery of Function; Retrospective Studies; Telephone; Time Factors; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice Quality; Young Adult

Compromised cough effectiveness is correlated with dysphagia and aspiration. Glottic insufficiency likely yields decreased cough strength and effectiveness. Although vocal fold augmentation favorably affects voice and likely improves cough strength, few data exist to support this hypothesis.. To assess whether vocal fold augmentation improves peak airflow measurements during maximal-effort cough following augmentation.. This case series study was conducted in a tertiary, academic laryngology clinic. Participants included 14 consecutive individuals with glottic insufficiency due to vocal fold paralysis, which was diagnosed via videostrobolaryngoscopy as a component of routine clinical examination. All participants who chose to proceed with augmentation were considered for the study whether office-based or operative augmentation was planned. Postaugmentation data were collected only at the first follow-up visit, which was targeted for 14 days after augmentation but varied on the basis of participant availability. Data were collected from June 5, 2014, to October 1, 2015. Data analysis took place between October 2, 2015, and March 3, 2017.. Peak airflow during maximal volitional cough was quantified before and after vocal fold augmentation. Participants performed maximal coughs, and peak expiratory flow during the maximal cough was captured according to American Thoracic Society guidelines.. Among the 14 participants (7 men and 7 women), the mean (SD) age was 62 (18) years. Three types of injectable material were used for vocal fold augmentation: carboxymethylcellulose in 5 patients, hyaluronic acid in 5, and calcium hydroxylapatite in 4. Following augmentation, cough strength increased in 11 participants and decreased cough strength was observed in 3. Peak airflow measurements during maximal cough varied from a decrease of 40 L/min to an increase of 150 L/min following augmentation. When preaugmentation and postaugmentation peak airflow measurements were compared, the median improvement was 50 L/min (95% CI, 10-75 L/min; P = .01). Immediate peak airflow measurements during cough collected within 30 minutes of augmentation varied when compared with measurements collected at follow-up (103-380 vs 160-390 L/min).. Peak airflow during maximal cough may improve with vocal fold augmentation. Additional assessment and measurements are needed to further delineate which patients will benefit most regarding their cough from vocal fold augmentation.

Topics: Carboxymethylcellulose Sodium; Cough; Durapatite; Female; Glottis; Humans; Hyaluronic Acid; Injections; Laryngoscopy; Male; Middle Aged; Treatment Outcome; Vocal Cord Paralysis

Trial vocal fold injection (TVFI) may be used prior to permanent medialization when voice outcome is uncertain. We aimed to determine whether voice outcomes of TVFI are predictive of, or correlate with outcomes after type I Gore-Tex medialization thyroplasty (GMT) in patients with nonparalytic glottic incompetence (GI).. Thirty-five patients with nonparalytic GI who underwent TVFI followed by GMT were retrospectively reviewed. Change in voice-related quality of life (VRQOL) after TVFI was compared to change in VRQOL 3 to 9 months after GMT. Similar comparisons were made for change in glottal function index (GFI) and change in grade, roughness, breathiness, asthenia, and strain (GRBAS). Sample correlation coefficients were calculated.. Change in VRQOL after TVFI showed good correlation with change in VRQOL after GMT, r = 0.55. Change in GFI after TVFI showed strong correlation with change in GFI after GMT, r = 0.74. Change in GRBAS after TVFI showed excellent correlation with change in GRBAS after GMT, r = 0.90.. The TVFI is a useful tool in nonparalytic GI when outcomes from glottic closure procedures are not clear. Voice outcome measures after TVFI strongly correlate with outcomes from GMT. These data may be used to more confidently counsel patients regarding their predicted outcomes of permanent medialization.

Topics: Atrophy; Carboxymethylcellulose Sodium; Cicatrix; Collagen; Female; Gelatin Sponge, Absorbable; Glottis; Humans; Laryngeal Diseases; Laryngoplasty; Male; Middle Aged; Polytetrafluoroethylene; Prognosis; Quality of Life; Retrospective Studies; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice

Vocal fold movement impairment (VFMI) due to neuronal injury occurs in 20% to 30% of surgeries in the region of the aortic arch. Early injection laryngoplasty can aid with postoperative pulmonary toilet in these high-risk cardiovascular patients. The purpose of this study is to determine whether continuing antiplatelet and anticoagulation therapy during awake transcervical injection laryngoplasty surgery is safe, and if there is any increase in bleeding complications in these patients.. This is a retrospective review of patients undergoing awake injection laryngoplasty surgery for VFMI between 2013 and 2016 at a tertiary academic center specializing in aortic and mediastinal diseases. Records were reviewed for patients regarding baseline antiplatelet or anticoagulation therapy, and whether these medications were stopped or continued preoperatively. The primary outcome was bleeding complications.. Of the 95 surgeries reviewed, 44 (46%) were performed for patients on antiplatelet therapy, and 71 (75%) for patients on anticoagulation therapy. None of the patients on antiplatelet therapy had their treatment discontinued. Of the patients on anticoagulation, 13 (16.4%) had their therapy held prior to surgery. There was no observed difference in bleeding complications between patients who were continued on antiplatelet or anticoagulation treatment versus those whose therapy was withheld.. These results suggest that patients undergoing awake transcervical injection laryngoplasty for VFMI can be maintained on antiplatelet or anticoagulation therapy without increased risk of bleeding. Further larger studies are needed to confirm these findings.. 4. Laryngoscope, 127:1850-1854, 2017.

Topics: Anticoagulants; Carboxymethylcellulose Sodium; Female; Humans; Injections; Intraoperative Care; Laryngoplasty; Male; Middle Aged; Neck; Platelet Aggregation Inhibitors; Postoperative Complications; Retrospective Studies; Vocal Cord Paralysis

Topics: Acellular Dermis; Carboxymethylcellulose Sodium; Drug Approval; Humans; Injections; United States; United States Food and Drug Administration; Vocal Cord Paralysis; Voice Disorders

The aim of this report was to describe the computed tomography features of injected carboxymethylcellulose and how it can be mistaken for tumor recurrence. Carboxymethylcellulose is a low-density injectable indicated for short-term vocal fold augmentation. When used in patients with head and neck cancer, differentiating this agent from a neoplastic recurrence can be difficult on imaging. The imaging findings of five patients who received carboxymethylcellulose augmentation are presented to illustrate a potential pitfall of image interpretation. When injectable carboxymethylcellulose is used in cancer patients, knowledge of the injection sites, material used, and procedural history can avoid misinterpretation of monitory imaging.

Topics: Aged; Carboxymethylcellulose Sodium; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Injections; Laryngectomy; Laryngoplasty; Male; Middle Aged; Tomography, X-Ray Computed; Vocal Cord Paralysis; Vocal Cords; Voice Quality

The primary objective of this study was to evaluate the effectiveness and safety of injection laryngoplasty using a temporary injectable agent in the acute setting for patients with unilateral vocal cord paralysis following thoracic surgical procedures.. Retrospective consecutive case series in an academic institution.. Inclusion criteria included patients acutely treated with injection laryngoplasty from January 1, 2006, to March 31, 2010, for a unilateral vocal cord paralysis that occurred after a thoracic surgical procedure (N = 20). All patients were injected with Radiesse Voice Gel using microlaryngoscopy technique.. The mean time to vocal cord injection from the time of thoracic surgery was 4.5 days. There was one operative-related complication of intraoperative bile reflux that caused a pneumonitis. Ninety percent of patients were recommended for strict nothing by mouth prior to injection. Of these, 94% were allowed an oral diet following injection, and 67% tolerated a regular diet. None of the patients required subsequent procedures for aspiration or dysphagia, and 25% required further intervention after discharge for persistent dysphonia. Patients with a known nerve transection had a higher rate of dysphonia requiring further surgical procedures than those who did not have a known nerve transection.. Acute treatment of thoracic surgery-related unilateral vocal cord paralysis with injection laryngoplasty appears safe and effective at preventing postoperative aspiration pneumonia and improves swallowing function to allow resumption of an oral diet. A single injection is often the only required treatment.

Topics: Adult; Aged; Carboxymethylcellulose Sodium; Esophagectomy; Female; Humans; Injections; Laryngoplasty; Male; Microsurgery; Middle Aged; Pneumonectomy; Postoperative Complications; Retrospective Studies; Thoracic Surgical Procedures; Treatment Outcome; Vocal Cord Paralysis; Young Adult

Injection laryngoplasty (IL) is a temporary intervention for unilateral vocal fold paralysis (UVFP). IL is often performed in patients with a potentially recoverable recurrent laryngeal nerve insult while awaiting spontaneous recovery, compensation, or definitive intervention. This study investigates the long-term outcomes of subjects treated with an IL.. Restrospective chart review.. A single-institution, retrospective review was performed from January 2004 to July 2008; subjects with potentially recoverable UVFP who underwent an IL were included.. The following etiologies were noted for the 42 subjects included: idiopathic in 13 (31%), iatrogenic in 25 (60%), infectious in two (5%), traumatic in one (2%), and stroke in one (2%). Ten subjects (24%) had full recovery of their paralysis, four (10%) partially recovered movement with adequate recovery of voice, 16 (40%) had no recovery of motion but compensation with adequate recovery of voice, 12 (29%) required further definitive intervention in the form of laryngeal framework surgery. Voice-related quality of life scores improved for all patients surveyed after IL and improved more for those who ultimately recovered or compensated.. The majority of subjects with potentially recoverable UVFP recover vocal fold motion and/or adequate voice after IL without permanent intervention.

Topics: Adult; Aged; Carboxymethylcellulose Sodium; Cohort Studies; Collagen; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Injections, Intralesional; Laryngoscopy; Male; Middle Aged; Recovery of Function; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice Quality

Temporary vocal fold injection is a valuable procedure for vocal fold paralysis or paresis of uncertain permanency and as a trial augmentation to decide the value of vocal fold augmentation. A new material made from glycerin, carboxymethylcellulose, and water has recently been developed for temporary vocal fold augmentation. Eleven patients underwent vocal fold injection for the treatment of glottal incompetence with this material. The duration of effectiveness of this injection material was 2 to 3 months depending on the injection amount. This new material satisfies several requirements for an ideal temporary vocal fold injection material in terms of injectability, convenience, duration of effectiveness, and safety. The authors conclude that this new material is a good option for temporary vocal fold augmentation.

Topics: Adult; Aged; Carboxymethylcellulose Sodium; Female; Glottis; Glycerol; Humans; Injections; Male; Middle Aged; Needles; Stroboscopy; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords; Voice Disorders; Voice Quality