Acute and subacute awake injection laryngoplasty for thoracic surgery patients

The rehabilitation of glottic incompetence by injection laryngoplasty is important in the management of thoracic surgery patients with vocal cord paralysis. This group of patients presents special considerations that favor injection under local anesthesia. The objective of this study is to characterize our experience with this minimally invasive approach in both the acute and subacute settings. The study was conducted using a retrospective chart review. From a database of 108 patients who received awake percutaneous injection laryngoplasty over a 3-year period, 15 cases were identified that underwent augmentation shortly following thoracic surgery. These records were reviewed for patient demographics, clinical characteristics, complications, and short-term outcomes. Fifteen patients were identified (12 male, 3 female); the age range for the group was 18-91 years (median=55 years). All the patients reported vocal improvement following injection; all 15 also were improved by perceptual assessment. Five of six dysphagic patients improved following injection. One patient's injection was aborted due to vocal fold edema; no significant bleeding or airway embarrassment was observed. No procedures were terminated because of patient discomfort. Awake percutaneous injection laryngoplasty for vocal paralysis can be performed safely in the postoperative thoracic surgery patient. Swallowing and voice complaints were almost universally improved following treatment. For patients who cannot tolerate or choose not to have open thyroplasty or vocal fold injection under general anesthesia, this procedure may offer a safe and effective alternative.