Still, he said, performing it with the patient awake does require sufficient skill and adequate facilities. Some people aren’t comfortable doing it in the office and if they don’t do a lot of them, it’s hard, Dr. Blitzer said. If they’re asleep, you can take all the time in the world. In the office, you have to be pretty good because the patients are spitting and coughing. You have to know how to give good anesthesia. You have to know how to work rapidly. You have to have two people.
Explore This IssueOctober 2009
Studies Comparing Complication Rates
There have not been a great deal of published data on the complication rates of awake versus asleep IL, but there have been some.
In one study (Anderson TD et al. J Voice 2004;18:392-7), researchers reported on two patients who developed submucosal deposits after collagen injection. The deposits disrupted the normal mucosal wave, causing voice problems, but this was resolved when the deposits were removed.
In another (Grant JR et al. J Voice 2008;22:245-50), a retrospective review over a three-year period, researchers found that all 15 patients undergoing awake laryngoplasty after thoracic surgery were found to have few complications and showed voice improvements.
Researchers have also reported that in 51 cases of thyrohyoid vocal fold augmentations, complications were rare, with just two problems-and those were self-limiting (Rees CJ. Otolaryngol Head Neck Surg 2008;138:743-6). In that study, six of the injections were aborted because surgeons could not negotiate a proper angle of injection.
There are a few published series, but most of those state negligible complication rates, Dr. Mathison said. In our review, we wanted to find any inadvertent event that resulted from the injection.
©2009 The Triological Society