Transcutaneous Teflon injection of the paralyzed vocal cord: a new technique

Because of anatomical deformity, trismus, or for other reasons, it may on occasion be impossible to visualize a larynx by the usual laryngoscopy methods. Such difficulties in patients who have paralytic dysphonia may also make it impossible to effect improved vocal cord closure by the usual techniques of Teflon injection. We have applied a new technique, detailed in this report, to these problem cases. Following topical anesthesia of the nose, nasopharynx, and larynx, 1% Xylocaine is injected over the cricothyroid membrane. A flexible or telescopic laryngoscope connected to a television camera is introduced through the nose or oral cavity, respectively. A 16-gauge spinal needle is introduced into the subglottic tracheal lumen via the cricothyroid membrane and directed into the undersurface of the paralyzed vocal cord under indirect visual control. Teflon is then injected, monitored via the television image. Our early experience with this simple technique indicates that voice improvement is comparable to that expected using conventional transoral laryngoscopic techniques.