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)
Lidocaine 4% drip method delivered by using curved Abraham cannula
for laryngeal surface topical anaesthesia prio to injection thyroplasty
performed 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
Atrophy of left true vocal fold as compared to the normal contralateral side.
Please note that the morphology of the paralysed vocal fold may be subte as compared to awake state (office procedure).
The amount of injection need to be justified based on preoperative
laryngosopy assesment (voice improvement can't be assessed under GA).
Abdominal fat harvesting. Copious saline irrigation.
The fat will be mixed with insulin 100 unit before loaded
into laryngeal injector or Bruening syringe.
Watch video of lipoinjection @ YouTube
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