Clinical Note |

Endoscopic Microflap Technique for the Management of Superficially Displaced Acellular Human Cadaveric Dermis During Injection Laryngoplasty

Robert A. Buckmire, MD
Arch Otolaryngol Head Neck Surg. 2009;135(2):205-208. doi:10.1001/archoto.2008.536.
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Injection laryngoplasty (IL), which has been practiced for more than a century, is a powerful, minimally invasive technique with the added potential of application in the outpatient setting. It has been advocated for the treatment of many laryngeal abnormalities that can result in symptomatic glottal incompetence. The recent increased attention to this procedure represents a resurgence of the laryngeal injection techniques that were widely touted in the 1960s and 1970s with the advent of polytef (Teflon) injection for paralytic dysphonia. Because several injectable dermal fillers, primarily designed for cosmetic uses, have since been developed, numerous new materials are currently available for vocal fold augmentation. Among them are micronized acellular human cadaveric dermis (Cymetra; LifeCell Corp, Branchburg, New Jersey), calcium hydroxylapatite, carboxymethylcellulose, and several products containing hyaluronic acid compounds. Newly described office-based, transnasal and percutaneous (thyrohyoid) routes for laryngeal injection have also been reported.1,2 Despite all of these nuances of technique and injectable materials, the common technical pitfalls and complications of IL remain largely unchanged.

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Figure 1.

Case 1. Flexible laryngoscopic image taken 3 months after injection of superficial acellular human cadaveric dermis (Cymetra; LifeCell Corp, Branchburg, New Jersey).

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Figure 2.

Case 1. Operative laryngoscopic image showing the removal of the cohesive mass of the superficial layer of the lamina propria through an endoscopic microflap approach.

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Figure 3.

Case 2. Preoperative microlaryngoscopic image.

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Figure 4.

Case 2. Flexible laryngoscopic image showing elevation of the microflap and isolation of the subepithelial mass.

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