Safety of Local Anesthetic Injection Laryngoplasty With Calcium Hydroxylapatite for Unilateral Vocal Fold Palsy: A Systematic Review.

BACKGROUND

Vocal fold injection (VFI) with calcium hydroxylapatite (CaHa) is a well-established surgical technique to improve speech and swallow outcomes in unilateral vocal fold palsy (UVFP). While often performed under local anesthetic (LA), there is limited data on its safety profile and the frequency of adverse events.

AIMS: To systematically evaluate the safety profile of CaHa VFI under LA for UVFP in adults.

METHODOLOGY: A systematic literature search was conducted of EMBASE and Ovid MEDLINE databases in August 2024. Results were screened, and inclusion criteria were applied. Studies were included if they reported complication data for eligible CaHa VFI procedures under LA for UVFP in adults.

RESULTS

Thirteen studies were included with a total of 1044 VFIs. Overall complication rate was 7.1% (n = 74), and the rate of major and minor complications was 3.7% (n = 39) and 3.4% (n = 35), respectively. LA VFI was abandoned in 10 cases (0.96%) and superficial injection was reported in thirteen cases (1.2%). Early extrusion of CaHa (n = 1) was also reported.

CONCLUSION

LA VFI is a viable clinic-based intervention with a favorable safety profile. Adequate topical anesthesia and precise injection are essential to minimize complications, particularly inappropriate placement of CaHa in the superficial lamina propria, which might be an underreported phenomenon.