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Accessing the vocal folds by transcutaneous injection
William Pearson1, Christoph T Hutchinson, J Pieter Noordzij
1Department of Anatomy and Neurobiology, Boston University School of Medicine, Massachusetts, USA.
Clinical Anatomy (New York, N.Y.)
|January 30, 2010
Summary
Technologically guided visualization significantly improves transcutaneous vocal fold (VF) injection success compared to anatomical knowledge alone. The cricothyroid membrane (CTM) approach offers more reliable access to the entire vocal fold length.
Area of Science:
- Otolaryngology
- Medical Imaging
- Anatomy
Background:
- Transcutaneous injection into the vocal fold (VF) is crucial for various therapeutic interventions.
- Accurate VF access remains challenging, necessitating improved injection techniques.
- Existing methods rely on anatomical landmarks, which can be imprecise.
Purpose of the Study:
- To compare the efficacy of different transcutaneous injection techniques for accessing the vocal fold (VF).
- To evaluate two distinct anatomical entry points: the thyrohyoid membrane (THM) and the cricothyroid membrane (CTM).
- To determine if technological visualization enhances VF access compared to anatomical knowledge alone.
Main Methods:
- Testing three techniques: geometric, flexible laryngoscope (FL) guidance, and computed tomography (CT) planning.
- Utilizing two approaches: THM and CTM injections in formalin-fixed human cadavers.
- Analyzing injection success rates via dissection and statistical analysis (chi-square test).
Main Results:
- Technology-guided techniques demonstrated significantly higher success rates than anatomical knowledge alone (X(2) = 6.55, P = 0.01).
- The hypothesis of equal access via THM and CTM was rejected; CTM provided more reliable access (X(2) = 5.33, P = 0.02).
- CTM approach ensures more consistent access to the entire vocal fold length.
Conclusions:
- Technological visualization significantly enhances the reliability of transcutaneous vocal fold injections.
- The cricothyroid membrane (CTM) is a superior entry point for achieving comprehensive vocal fold access.
- These findings support the integration of advanced imaging and guidance in laryngeal procedures.
