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Injection Thyroplasty: External Laryngeal Landmarks

A preparation of human larynx showing applied anatomy relevant to external approach of injection thyroplasty.   Triangle - infrahyoid approach where the needle introduced at superior thyroid notch of thyroid cartilage and rounded rectangle for infrathyroid approach where the needle introduced into cricothyroid membrane.  Endoscopic view is achieved by transnasal flexible laryngoscopy.  (1 - cricothyroid muscle, 2 - thyroid cartilage, 3 - thyrohyoid muscle, 4 - tracheal cartilage, dot - central point of superiot thyroid notch)

Laryngeal Surface Topical Anaesthesia

Lidocaine 4% drip method delivered by using curved Abraham cannula

for laryngeal surface topical anaesthesia prio to injection thyroplasty

performed as an office procedure.

Injection Thyroplasty as An Office Procedure

      Phonatory gap upon phonation:            Injection of material into vocal fold


  Vocal fold appearance upon breathing   Closure of phonatory gap upon phonation

                    Post-injection                                      Post-injection

Collagen Injection: Cymmetra®

Calcium Hydroxyapatite Injection: Radiesse™-Radiance FN

Vocal Cord Medialization to Treat Vocal Cord Paralysis (HD)

Gelfoam [Absorbable Gelatin Powder] as a Temporary Injectable Material for Medialization Thyroplasty

Injection Thyroplasty Under GA with Hyaluronic Acid


Atrophy of left true vocal fold as compared to the normal contralateral side.

BEFORE Injection

Please note that the morphology of the paralysed vocal fold may be subte as compared to awake state (office procedure).


AFTER Injection

The amount of injection need to be justified based on preoperative

laryngosopy assesment (voice improvement can't be assessed under GA).

Autologous Lipoinjection

             Abdominal fat harvesting.                    Copious saline irrigation.


The fat will be mixed with insulin 100 unit before loaded 

into laryngeal injector or Bruening syringe.



Endoscopic-assisted lipoinjection.


Watch video of lipoinjection @ YouTube


Suggested reference:

Mallur PS, Rosen CA. Vocal fold injection: review of indications, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol. 2010 Dec;3(4):177-82. Epub 2010 Dec 22