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Clinical and Experimental Otorhinolaryngology > Accepted Articles
doi: https://doi.org/10.21053/ceo.2021.02264    [Accepted]
Real-time Light-guided Vocal Fold Injection via Cricothyroid Membrane in Unilateral Vocal Fold Paralysis: A Human Pilot Study
Gene Huh1,2 , Pil Geun Jang1 , Seung Hoon Han1,2 , Ramla Talib Mohammad1 , Woo-Jin Jeong1,2 , Wonjae Cha1,2
1Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea
2Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
Correspondence  Wonjae Cha ,Tel: 031-787-7413, Fax: 031-787-4057, Email: chawonjae@gmail.com
Received: December 23, 2021; Revised: February 27, 2022   Accepted: March 12, 2022.  Published online: April 8, 2022.
Purpose: Vocal fold injection (VFI) via the cricothyroid (CT) membrane is used in the treatment of various VF diseases. The technical challenges of this technique are mainly related to the invisibility of the needle. Recently, real-time light-guided VFI (RL-VFI) was developed for simultaneous injection under light guidance in the CT approach. Herein, we present the first clinical trial of RL-VFI investigating the feasibility and safety of the new technique in unilateral vocal fold paralysis (VFP).
This was a prospective pilot study that enrolled 40 patients, who were treated with RL-VFI for unilateral VFP between September 2020 and August 2021. Adverse events were monitored during the procedure and for 4 weeks postoperatively. Voice Handicap Index-10, GRBAS scale, aerodynamic study, and acoustic analysis were evaluated to compare the voice improvement after 4 weeks with the baseline values.
The needle tip was intuitively identified by the red light, and the mean procedure time was 95.6 ± 40.6 seconds for the initial injection, while it required 79.2 ± 70.5 seconds for the additional injection. The injection was proceeded under light guidance without additional manipulation after the needle reached the intended point. No acute and delayed adverse events were reported. Among the 40 patients, 36 completed voice analysis after 4 weeks. Subjective and objective voice parameters, including voice handicap index, GRBAS scale, maximum phonation time, mean expiratory airflow, fundamental frequency, jitter, shimmer, and noise-toharmonics ratio improved significantly after RL-VFI (P < 0.05) while expiratory volume was retained.
RL-VFI is feasible and safe for treating patients with unilateral VFP. This technique is anticipated to improve the precision and safety of the CT approach in the treatment of unilateral VFP. This study provides a rationale for further structured clinical studies.
Keywords: vocal fold injection; real-time light-guided vocal fold injection; unilateral vocal fold paralysis; injection laryngoplasty; cricothyroid membrane approach
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