Vocal Cord Injection Laryngoplasty

A vocal fold injection is a procedure in which a substance is directly injected into the vocal fold. This may be a filling agent such as collagen, or a medication such as a steroid. Vocal fold injections may be performed with a patient awake in an office setting or asleep in an operating room.

Vocal fold injections with filling agents are most commonly performed for conditions of paralysis and for treatment of the aging voice. They may also be performed for other causes of glottal insufficiency such as scar. Vocal fold augmentation is performed in the operating room along with microlaryngoscopy. With a patient asleep a laryngoscope is inserted in a patient’s mouth and used to examine a patient’s vocal folds. A telescope or a microscope is used to magnify the view through the laryngoscope. A long needle is used to inject filling agent to the vocal fold. Once an injection is performed there is an obvious change in the shape of the vocal fold. Filling agents may be temporary, intended to last for only a few weeks, or more permanent in nature. Filling agents may also be synthetic, or natural such as use of a patient’s own fat for injection into the vocal folds.

Left vocal fold paralysis, before left vocal fold augmentation. The vocal fold is paralyzed and is noticably thinner than the right side.

A needle is being introduced into the left vocal fold. A microscope is used to guide placement of the injection.

Left vocal fold injection – Before (left image) and after (right image). Note that the left vocal fold has is overcorrected to account for absorbption.

Medications to treat disease may also be injected. For example, steroids may used in the treatment of granuloma. Certain medications, such as cidofovir have been used for management of papilloma. In these applications the only difference is the location of the injection – the tools used are very similar.