The setting for the injection, whether it is the office or the operating room, depends on the comfort and experience of the surgeon, patient anatomy, and tolerance of laryngoscopy, Dr. Francis said. When choosing an injection technique—transoral, transthyrohyoid, transcricothyroid, or transthyroid cartilage—patient anatomy and surgeon preference are major considerations. “The true vocal fold is not in the same position in every single patient by any means at all,” Dr. McWhorter said. There is variability in the level of the vocal fold relative to the top and bottom of the thyroid cartilage, which affects access, he added.
The advantages to performing the procedure in the operating room rather than in the office are that it is simpler to add more material if needed and that the surgeon has more control, which generally leads to more precision, Dr. McWhorter said. He also noted that the published literature suggests that outcomes and risks in intra-office when compared with intra-operative injections do not differ significantly.
Type 1 Thyroplasty
Adam Rubin, MD, director of the Lakeshore Professional Voice Center in St. Clair Shores, Mich., waits nearly a year after the onset of vocal fold paralysis to see how a patient progresses before performing type 1 thyroplasty. “It’s so easy to perform injection laryngoplasty and temporize people and help patients’ symptoms, so why not give a paralyzed vocal fold the best chance to regain mobility or for synkinesis?” he said.