Awake Trancervical Injection Laryngoplasty - Thyrohyoid Membrane Approach

Video Type: CVideo
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Author: Julina Ongkasuwan
Published:
Specialties: Otolaryngology
Schools: Baylor College of Medicine
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Basic Info

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

Advanced

Procedure

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.

Indications

Vocal fold paralysis/paresis, presbylarynx, glottic incompetence

Contraindications

airway obstruction, uncooperative patient

Instrumentation

Setup

1.The patient should be sitting up in a âsniffingâ position.
2.Medications should be drawn up in advance.

Preoperative Workup

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.

Anatomy and Landmarks

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.

Advantages/Disadvantages

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.

Complications/Risks

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.

Disclosure of Conflicts

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.

Acknowledgements

none

References

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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