warfarin and Vocal-Cord-Paralysis

Injection medialization laryngoplasty is a procedure that has many advantages in treating vocal fold paralysis; however, undesired complications can occur. We experienced a case of a pulmonary embolism, suspected in a patient who had undergone an injection laryngoplasty with calcium hydroxylapatite (CaHA). The patient suffered dyspnea after undergoing the injection laryngoplasty. Chest embolism computed tomography (CT) scan revealed a new lesion of enhancing materials at the pulmonary vasculature in the right upper lobe. The CaHA embolism was suspected, and the patient was treated with warfarin for 12 months. The patient's symptom of dyspnea nearly disappeared and a follow up chest embolism CT scan revealed no signs of the previous lesion. Thus, we would like to report this rare case along with a review of the literature.

Topics: Biocompatible Materials; Durapatite; Female; Humans; Injections, Intralesional; Laryngoplasty; Middle Aged; Postoperative Complications; Pulmonary Embolism; Tomography, X-Ray Computed; Treatment Outcome; Vocal Cord Paralysis; Warfarin

Our aim was to review the safety of percutaneous injection laryngoplasty using bovine crosslinked collagen, focusing specifically on two often-stated concerns: injecting patients who are taking the anticoagulant medication warfarin, and injecting patients without prior skin hypersensitivity testing.. Retrospective chart review of injection laryngoplasty performed between 1997 and 2006 at the University of California, Los Angeles.. The study group consisted of 895 patients who underwent 1290 injection laryngoplasty procedures. No bleeding complications were noted in 59 patients taking warfarin. No allergic complications were reported in 845 patients who did not undergo skin hypersensitivity testing before injection laryngoplasty.. Percutaneous bovine crosslinked collagen injection laryngoplasty is safe in patients taking warfarin. Skin testing for hypersensitivity does not appear to be necessary before injection.. Patients on warfarin are candidates for injection laryngoplasty without the need to discontinue the medication. Eliminating skin hypersensitivity testing before percutaneous bovine crosslinked collagen injection laryngoplasty allows for a prompt treatment of glottic insufficiency.

Topics: Aged; Animals; Anticoagulants; Biocompatible Materials; Cattle; Collagen; Female; Glottis; Humans; Hypersensitivity; Injections, Intradermal; Laryngeal Diseases; Male; Postoperative Complications; Postoperative Hemorrhage; Prostheses and Implants; Retrospective Studies; Safety; Vocal Cord Paralysis; Voice Disorders; Warfarin