![]() If the Storz injectior is not available, the syringe that the implant comes packaged in is adequate. Each click of the Storz injector delivers 0.04cc of implant. We use a Brünings-type laryngeal injector that allows for precise implant delivery (Karl Storz, Tuttlingen, Germany). Use of the Hunsaker tube affords an unobstructed view of both vocal folds while providing continuous ventilation. We use a Hunsaker Mono-Jet subglottic ventilation tube (Xomed Surgical Products Jacksonville, Fla.). The patients’ eyes and teeth are protected and microlaryngoscopy is performed. Because the implant is potentially permanent and the implant can have detrimental effects on vocal fold vibration if injected superficially, we perform all of our injections per-orally under anesthesia with microscopic guidance. The procedure can be performed in a patient who is awake, or in an individual who is asleep under the effects of general anesthesia. This patient would be a perfect CaHA injection patient.ĬaHA can be injected into the vocal folds percutaneously (through the skin) or per-orally (through the mouth). Videostroboscopic image of bowed, slightly atrophic vocal folds with a 2mm gap at the point of vocal process contact. Larger gaps may be better treated with an implant placed externally through a small cervical incision (medialization laryngoplasty +/- arytenoid repositioning). Injection augmentation of the vocal folds with CaHA is best reserved for small and medium sized glottal gaps (space between the vocal folds). We routinely inject both vocal folds at the same time. Patients with Parkinson’s hypophonia have also benefited from the procedure. We also frequently utilize the implant to reverse age-related changes in the vocal fold (presbylarynx) – the so-called Voice Lift Procedure. The implant can be injected into a paralyzed (immobile) vocal fold or a paretic (weak but mobile) vocal fold. We have injected over 100 vocal folds with excellent results. Our re-injection rate, however, is only 15%. ![]() We therefore tell all of our patients that a second injection may be necessary 3-4 months after the initial procedure. There is some resorption of the CaHA carrier at three months. The majority of patients that we have injected, however, have had long-term improvement. We are therefore unable to state with certainty that the implant is permanent. We have been using the implant for injection into the vocal fold for slightly over 2 years. It is highly biocompatible (well accepted for implantation by the body) and has the potential for long-term and even permanent vocal fold augmentation. Calcium hydroxylapatite (CaHA) is the primary mineral constituent of bone and teeth. Synthetic calcium hydroxylapatite (Radiesse, BioForm Inc., Franksville, WI, USA) was approved for vocal fold augmentation by the United States Food and Drug Administration Center for Devices and Radiological Health in January, 2002. c) Medialized, plump vocal folds after injection of 0.15cc of CaHA bilaterally. Injection Augmentation of the Vocal Folds with Calcium HydroxylapatiteĮndoscopic visualization of the vocal folds during surgery.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |