In-Office Awake Vocal Fold Steroid Injection

Video Type: CVideo
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Author: R. Jun Lin
Published:
Specialties: Otolaryngology
Schools: University of Pittsburgh Voice Center
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Basic Info

Contributors: Clark A. Rosen

Superficial injection of steroids into the true vocal folds can be performed to reduce or prevent vocal fold scar formation as well as for treatments of benign vocal fold lesions.

DOI: http://dx.doi.org/10.17797/zle2prpaif

Editor Recruited By: Michael M. Johns, III, MD

Advanced

Procedure

In-office awake vocal fold steroid injection

Indications

Mild to moderate vocal fold scar
Benign vocal fold lesions
Post-benign vocal fold lesion removal to facilitate healing by reducing inflammation

Contraindications

Need for global vocal fold augmentation
Patient anxiety
Significant gag reflex
Medical comorbidities that contraindicate an in-office procedure

Instrumentation

Setup

Patient sits in an upright position in a chair. Physician driving the laryngoscope stands on the patient¢s right side while the assistant, who passes the lidocaine drip catheter and injector, stands on the patient¢s left.

Preoperative Workup

Blood pressure and heart rate measurements before the procedure.

Anatomy and Landmarks

Good knowledge of the laryngeal anatomy.

Advantages/Disadvantages

Advantages: Avoids general anesthesia, easy patient tolerability
Disadvantages: Usually done serially thus requires multiple procedures

Complications/Risks

Vasovagal reaction, epistaxis, vocal fold hematoma, vocal fold atrophy after serial dexamethasone injection

Disclosure of Conflicts

Vasovagal reaction, epistaxis, vocal fold hematoma, vocal fold atrophy after serial dexamethasone injection

Acknowledgements

References

Campagnolo AM, Tsuji DH, Sennes LU, Imamura R, Saldiva PH. Histologic study of acute vocal fold wound healing after corticosteroid injection in a rabbit model. Ann Otol Rhinol Laryngol. 2010;119(2):133-9.

Zhou H, Sivasankar M, Kraus DH, Sandulache VC, Amin M, Branski RC. Glucocorticoids regulate extracellular matrix metabolism in human vocal fold fibroblasts. Laryngoscope. 2011;121(9):1915-9.

Wang CT, Lai MS, Hsiao TY. Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions. J Voice. 2015;29(5):578-87.

Shi LL, Giraldez-Rodriguez LA, Johns MM 3rd. The Risk of Vocal Fold Atrophy after Serial Corticosteroid Injections of the Vocal Fold. J Voice. 2015 Nov 24. [Epub ahead of print]

Office steroid injections of the larynx.
Mortensen M, Woo P.
Laryngoscope. 2006 Oct;116(10):1735-9.

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