Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026
Real-Time Light-Guided Vocal Fold Injection for Unilateral Vocal Fold Paralysis: Experience From 378 Consecutive Cases.
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Kim Seo Young, Ji Jeong-Yeon, Jeong Woo-Jin, Cha Wonjae
Аннотация
OBJECTIVE: Accurate needle localization is a key challenge in the cricothyroid (CT) approach to vocal fold injection (VFI) due to invisibility. Real-time light-guided VFI (RL-VFI) was developed to enhance precision through simultaneous light guidance. This study aimed to evaluate safety and feasibility of office-based RL-VFI with hyaluronic acid (HA) in a large-scale (>300), consecutive patients with unilateral vocal fold paralysis (UVFP).
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary referral center.
METHODS: A total of 378 RL-VFI with HA were consecutively performed on 257 UVFP patients. Complications were monitored intraoperatively and for 4 weeks post-procedure. Voice outcomes were assessed using voice handicap index (VHI)-10, grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, acoustic analysis, and aerodynamic study at baseline and 4 weeks postoperatively.
RESULTS: Most cases involved left-sided paralysis (83.7%), primarily due to surgery (63.4%) or metastasis (26.1%). In all cases, HA was injected at the intended point in the paralyzed vocal fold under light guidance, with no superficial injection or mucosal penetration. Average procedure time was 114.0 ± 105.1 seconds for the initial injection and 80.6 ± 77.7 seconds for additional injections. No serious acute or delayed complications occurred. Among 180 cases with complete voice assessments, significant improvements were observed in voice-related parameters including VHI-10, GRBAS scale, maximum phonation time, mean expiratory airflow, jitter, shimmer, and noise-to-harmonics ratio.
CONCLUSION: RL-VFI with HA is a feasible and safe technique for treating patients with UVFP. It enables precise confirmation of needle tip localization and facilitates accurate injection into the intended target during the CT approach.
STUDY DESIGN: Retrospective cohort study.
SETTING: Tertiary referral center.
METHODS: A total of 378 RL-VFI with HA were consecutively performed on 257 UVFP patients. Complications were monitored intraoperatively and for 4 weeks post-procedure. Voice outcomes were assessed using voice handicap index (VHI)-10, grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, acoustic analysis, and aerodynamic study at baseline and 4 weeks postoperatively.
RESULTS: Most cases involved left-sided paralysis (83.7%), primarily due to surgery (63.4%) or metastasis (26.1%). In all cases, HA was injected at the intended point in the paralyzed vocal fold under light guidance, with no superficial injection or mucosal penetration. Average procedure time was 114.0 ± 105.1 seconds for the initial injection and 80.6 ± 77.7 seconds for additional injections. No serious acute or delayed complications occurred. Among 180 cases with complete voice assessments, significant improvements were observed in voice-related parameters including VHI-10, GRBAS scale, maximum phonation time, mean expiratory airflow, jitter, shimmer, and noise-to-harmonics ratio.
CONCLUSION: RL-VFI with HA is a feasible and safe technique for treating patients with UVFP. It enables precise confirmation of needle tip localization and facilitates accurate injection into the intended target during the CT approach.