Needle Fracture During Injection Medialization Laryngoplasty

OBJECTIVES

Awake injection medialization laryngoplasty is one of the most common therapeutic procedures done by laryngologists in the office or at the bedside. Complications of injection needle fracture are rarely reported.

METHODS

This is a case report of a 59-year-old male inpatient who developed left vocal fold immobility with significant glottic insufficiency after pneumonectomy for a large left-sided lung cancer. During bedside injection medialization using thyrohyoid approach, the 25 G needle fractured at the hub and was embedded partly in pre-epiglottic space and partly extending over rima glottidis.

RESULTS

Fractured needle was successfully retrieved at the bedside with an endoscopic biopsy forcep using flexible bronchoscope.

CONCLUSION

It is imperative to be aware of rare complications of routine procedures like injection laryngoplasty so they can be managed timely and effectively.

Current trends in practices in the treatment of pediatric unilateral vocal fold immobility: A survey on injections, thyroplasty and nerve reinnervation

INTRODUCTION

The objective of this study was to poll pediatric otolaryngologists with a special interest in pediatric laryngology on their experience with injection medialization laryngoplasty (IML), thyroplasty, and reinnervation procedures in order to reflect on changing clinical practices.

METHOD

A 10-items questionnaire was designed to inquire about current management practices in the treatment of symptomatic UVFI. The 59 members of an ASPO pediatric laryngology working group received the anonymous online survey. A 47% (28/59) response rate was obtained over a 2 weeks period.

RESULTS

Carboxymethylcellulose gel (Prolaryn) is the most popular injectable material used in the setting of IMLs (preferred by 46%; 13 respondents). Most clinicians perform IMLs in the operating room. However, 14% (4/28) of respondents currently perform office-based injections on older patients. When faced with the case of a young child with longstanding iatrogenic VFP, most respondents (41%; 11/27) would perform an IML alone as a first step for management. 37% (10/27) of respondents would inject and perform a laryngeal EMG while 22% (6/27) would offer reinnervation and concomitant IML. When faced with the case of a teenager with long-standing VFP, the polled physicians' opinions were divided: 37% (10/27) favored reinnervation and concomitant IML, while 26% (7/27) would proceed to an IML only. The remaining 37% (10/27) would first assess for vocal atrophy through LEMG or visual inspection.

CONCLUSIONS

Two significant shifts in practice seem to have occurred. First, ansa-RLN reinnervation procedures are now being considered as a first line treatment for a subset of patients in whom only IML was considered in the past. In fact, more than 20% of respondents did consider this route of management. Second, there is an increased use of in-office augmentations for older pediatric patients.