Inflammatory Reactions to Laryngeal Injection of Hyaluronic Acid Derivatives

To report the rate and describe the characteristics and management of inflammatory reactions following injection laryngoplasty with hyaluronic acid derivatives.

Single institution, retrospective review.

Adult and pediatric patients who underwent injection laryngoplasty with hyaluronic acid derivatives from 2013 to 2020 were identified. Demographics, indication for injection, type and volume of injected material, and use of general anesthesia were obtained. When a postoperative inflammatory response occurred, information regarding clinical presentation, timing, and subsequent management was collected.

A total of 464 patients who underwent 536 laryngeal injections with hyaluronic acid derivatives were included. There were 365 adult patients (median age 62 years) who underwent 431 injections and 99 pediatric patients (median age 2 years) who underwent 105 injections. The most common indications for injection were abnormal vocal fold mobility (70.3%) and aspiration (83.8%) for adult and pediatric patients, respectively. Juvéderm® was used in 449 cases (79.8% adult, 100% pediatric), and Restylane® was used in the remaining adult cases (20.2%). Procedures were mostly performed under general anesthesia (67.7% adult, 100% pediatric) with median injection volumes of 0.6 mL for adult and 0.3 mL for pediatric patients. An inflammatory reaction occurred following 3 of 536 injections (0.6%), all utilizing Juvéderm®. All three patients presented with stridor, dyspnea, and laryngeal edema within two days of injection. Each patient was admitted for observation and successfully treated with intravenous steroids and inhaled racemic epinephrine. One patient with comorbid pneumonia was intubated and required concomitant treatment with broad-spectrum antibiotics.

Inflammatory reactions to hyaluronic acid derivatives used in injection laryngoplasty are rare but represent significant patient morbidity and can be managed with anti-inflammatory and airway stabilizing measures. Patients should be counseled appropriately regarding the risks of injection laryngoplasty with hyaluronic acid derivatives.