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Early versus late injection medialization for unilateral vocal cord paralysis.
Laryngoscope. 2010 Oct; 120(10):2042-6.L

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, χ2 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.

Authors+Show Affiliations

Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. afriedman3@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20824787

Citation

Friedman, Aaron D., et al. "Early Versus Late Injection Medialization for Unilateral Vocal Cord Paralysis." The Laryngoscope, vol. 120, no. 10, 2010, pp. 2042-6.
Friedman AD, Burns JA, Heaton JT, et al. Early versus late injection medialization for unilateral vocal cord paralysis. Laryngoscope. 2010;120(10):2042-6.
Friedman, A. D., Burns, J. A., Heaton, J. T., & Zeitels, S. M. (2010). Early versus late injection medialization for unilateral vocal cord paralysis. The Laryngoscope, 120(10), 2042-6. https://doi.org/10.1002/lary.21097
Friedman AD, et al. Early Versus Late Injection Medialization for Unilateral Vocal Cord Paralysis. Laryngoscope. 2010;120(10):2042-6. PubMed PMID: 20824787.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early versus late injection medialization for unilateral vocal cord paralysis. AU - Friedman,Aaron D, AU - Burns,James A, AU - Heaton,James T, AU - Zeitels,Steven M, PY - 2010/9/9/entrez PY - 2010/9/9/pubmed PY - 2010/10/30/medline SP - 2042 EP - 6 JF - The Laryngoscope JO - Laryngoscope VL - 120 IS - 10 N2 - 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, χ2 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. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/20824787/Early_versus_late_injection_medialization_for_unilateral_vocal_cord_paralysis_ L2 - https://doi.org/10.1002/lary.21097 DB - PRIME DP - Unbound Medicine ER -