What are the long-term outcomes of patients with unilateral vocal fold paralysis (UVFP) who are treated with injection laryngoplasty (IL)?
Background: IL, a temporary intervention for UVFP, is often performed in patients with a potentially recoverable recurrent laryngeal nerve insult while they await spontaneous recovery, compensation or definitive intervention. The decision to treat UVFP is historically based on the duration of paralysis, with laryngeal framework surgery a permanent intervention performed in cases of UVFP that do not recover. This study was designed to evaluate the outcomes of patients with potentially recoverable recurrent laryngeal nerve injury who are treated with IL.
Study design: Retrospective review
Setting: Emory Voice Center, Atlanta, Georgia
Synopsis: The review of 42 patients who underwent IL between January 2004 and July 2008 included the following etiologies: 31 percent idiopathic, 60 percent iatrogenic, 2 percent infectious, 2 percent traumatic and 2 percent stroke. While 24 percent (10 patients) experienced full recovery of their paralysis, 10 percent (four patients) partially recovered movement with adequate recovery of voice, and 40 percent (16 patients) experienced no recovery of motion but had compensation with adequate recovery of voice, 29 percent (12 patients) required further definitive intervention in the form of laryngeal framework surgery. Voice-related quality of life scores improved for all patients surveyed after IL and improved more for those who ultimately recovered or compensated. Of those patients who experienced compensation, 10 of 16 (59 percent) had follow-up of more than six months after IL without requiring repeat intervention, suggesting that the voice improvement benefits of IL might last longer than the expected duration of the injectable material.
Bottom line: Of patients with potentially recoverable UVFP who underwent IL for temporary relief and had appropriate follow-up, the majority (71 percent) recovered or compensated and did not require definitive surgical intervention. Also, recovery of voice was more common than recovery of motion after IL.
Citation: Arviso LC, Johns MM, Mathison CC, et al. Long-term outcomes of injection laryngoplasty in patients with potentially recoverable vocal fold paralysis. Laryngoscope. 2010;120(11):2237-2240.
—Reviewed by Sue Pondrom