Early versus late injection medialization for unilateral vocal cord paralysis

OBJECTIVES: To evaluate whether the timing of early (≤6 months from time of nerve injury) vs. late (>6 months) injection medialization laryngoplasty impacts the need for subsequent open-neck reconstruction to restore vocal function in patients with unilateral vocal cord paralysis. STUDY DESIGN: Retrospective chart review. METHODS: A total of 112 outpatient or hospitalized adults with dysphonia resulting from postsurgical or idiopathic unilateral vocal cord paralysis were identified who were injected as initial treatment within 1 year of onset of their paralysis. All subjects underwent awake, transoral, paraglottic injection with absorbable hyaluronic-acid gel. Patients with documented recovery of vocal cord mobility (22), active disease directly affecting the recurrent laryngeal nerve (8), <3 months of follow-up after injection (time for gel to be reabsorbed) (34), or deaths within 1 year after the onset of paralysis (13) were excluded, leaving a study population of 35 patients. RESULTS: Twenty of 32 (62.5%) patients with early injection medialization maintained an adequate voice, obviating the need for open-neck phonosurgical reconstruction; their follow-up from onset of paralysis ranged from 4.0 to 41.8 months (mean 15.2). None of the three patients undergoing late injection (>6 months postparalysis) avoided phonosurgical reconstruction (P = .03, χ2 test). CONCLUSIONS: Patients receiving early injection medialization for vocal cord paralysis were less likely to require transcervical reconstruction. We believe that early medialization creates a more favorable vocal cord position for phonation that can be maintained by synkinetic reinnervation, in contrast to the final position of a lateralized vocal cord being determined solely by reinnervation.