Endoscopic rehabilitation of vocal cord paralysis with a silicone elastomer suspension implant

OBJECTIVES: Because of the side effects of Teflon, the risk of infection from the use of collagen, autologous fat resorption, and the lack of alternative substances, injection laryngoplasty tends to be replaced by laryngeal framework surgery as the method of choice for the treatment of unilateral vocal cord recurrent paralysis (LP). The aim of this study was to evaluate the results, for morbidity and voice quality, of treating this paralysis by injection of a silicone suspension elastomer implant (SSEI). STUDY DESIGN: The study was retrospective, and 19 patients were included. Average follow-up was 25 months (range: 8.3-43). METHODS: Each patient underwent clinical and videostroboscopic assessment, and had an electroglottographic recording. Subjective assessment was obtained by self -evaluation. Results were classified as good, fair, or poor, and were based on 2 objective and 3 subjective criteria. A search was made for biologic signs of autoimmune disorders. RESULTS: Good, fair, and poor results were respectively 79%, 16%, and 5%. Each set of subjective data showed voice improvement (P < 0.05). The fundamental frequency range, percentage of irregularity, and aspiration decreased significantly (P < 0.05). There was only one case of postoperative dyspnea, which resolved after steroid injection. No biologic signs of autoimmune disorders were found. CONCLUSIONS: The use of SSEI is safe. Injection laryngoplasty is easy to perform and avoids cervical scarring. Its results are comparable to those obtained with other techniques, including laryngeal framework surgery, even if there is no standard criterion for the evaluation of voice quality. SSEI injection can reasonably be proposed as a surgical treatment for permanent unilateral vocal cord LP.