Complications of Various Materials for Injection Laryngoplasty: Systematic Review and Meta-Analysis.

OBJECTIVE

The purpose of this review is to investigate the complications of various common materials for injection laryngoplasty (IL): autologous fat (AF), calcium hydroxylapatite (CaHA), hyaluronic acid (HA), and carboxymethylcellulose (CMC).

METHODS

The literature was queried for articles reporting complications in patients undergoing IL with AF, CaHA, HA, or CMC. Outcome measures include proportions (%) with 95% confidence intervals (CI) of procedural complications (inflammation, granuloma, hematoma, delayed cyst, misplaced/superficial injection, extrusion/migration, and inadvertent overinjection), airway compromise (stridor, dyspnea), and postinjection intervention (steroid treatment, intubation, and tracheotomy). A comparison of proportions, expressed as difference (Δ) and 95% CI, was completed between materials.

RESULTS

Of 551 abstracts identified, 58 studies (N = 2868 patients) were included. Procedural complications following CaHA-IL (11.03% [CI: 4.7-19.5]) occurred at a significantly higher rate than AF-IL (Δ5.97 [CI: 3.1-8.6], P = 0.0001), HA-IL (Δ5.60 [CI: 3.2-8.0], P < 0.0001), and CMC-IL (Δ7.68 [CI: 1.3-10.7], P = 0.024). The highest incidence of airway compromise occurred in HA-IL (3.73% [CI: 1.6-6.6]), followed by AF-IL (1.85% [CI: 0.86-3.5]) and CaHA-IL (0.69% [CI: 0.23-1.6]). Airway compromise was significantly higher following HA-IL compared with CaHA-IL (Δ3.05 [CI: 1.6-4.6], P < 0.0001). There was no significant difference in airway compromise between AF-IL and CaHA-IL (Δ1.17 [CI: -0.07-2.0], P = 0.058) or AF-IL and HA-IL (Δ1.88 [CI: -0.08-3.6], P = 0.055). There was no significant difference in frequency of postinjection intervention in patients undergoing AF-IL (3.53% [CI: 1.8-6.2]) and HA-IL (2.52% [CI: 1.6-3.8]) (Δ1.01 [CI: -1.0-3.9], P = 0.360).

CONCLUSIONS

IL is generally safe with the commonly used materials (AF, CaHA, HA, and CMC), with a low overall complication rate across materials. CaHA demonstrates a higher rate of procedural complications, while HA carries a mildly higher risk for airway compromise. Clinicians should select injection material based on patient factors with an awareness for the likelihood of risks based on material.