Chronic infection is a common problem, he said, because crusting compromises the mucosa’s resistance to infection. “You can clear this temporarily, but it is constantly there and constantly complicating things,” he added.
Explore this issue:
March 2016A recent study has confirmed that injection augmentation and medialization laryngoplasty are generally safe in the radiated larynx (Otolaryngol Head Neck Surg. 2015;153:582-585); however, there might be more risk when it comes to arytenoid adduction.
Dr. Sulica drew particular attention to the minithyrotomy procedure for scarring, described by Stephen D. Gray, MD, in 1999. It’s a combination of an external neck and laryngoscopic technique in which a submucosal implant is placed through a thyroid cartilage window. For the implant, Dr. Sulica typically uses a generous amount of fat, “more than you think you’ll need,” which is usually readily available. “I think the minithyrotomy is an interesting approach to access the lamina propria, or where the lamina propria would have been in the scarred vocal fold, without an epithelial incision.”
Thomas Collins is a freelance medical writer based in Florida.
Take-Home Points
- Late surgical rehabilitation after radiation and surgery should involve understanding and modulating factors that are unfavorable, minimizing long-term morbidity and preserving function, and acting expediently when necessary.
- When listening to a patient, realize that the breathier he or she is, the more likely surgery will help.